{"hospital_name":"El Camino Hospital","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["El Camino Hospital","El Camino Hospital Los Gatos","El Camino Hospital Mountain View","El Camino Inaptient Rehabilitation Center","El Camino Inpatient Psych"],"hospital_address":["2500 Grant Road, Mountain View, CA 94040","815 Pollard Road, Los Gatos, CA 95032","2500 Grant Road, Mountain View, CA 94040","355 Dardanelli Lane, Los Gatos, CA 95032","2590 Grant Road, Mountain View, CA 94040"],"license_information":{"license_number":"070000660","state":"CA"},"type_2_npi":["1093712374"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Raju Iyer"},"financial_aid_policy":["75% off of facility standard gross charges. 60% off of professional gross charges."],"standard_charge_information":[{"description":"gadobenate dimeglumine per 1 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"270516415","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"186198904","type":"NDC"}],"standard_charges":[{"gross_charge":40.74,"discounted_cash":10.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.25 mg/2 mL suspension for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93681519","type":"NDC"}],"standard_charges":[{"gross_charge":12.13,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.25 mg/2 mL suspension for nebulization 2 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"115168774","type":"NDC"}],"standard_charges":[{"gross_charge":36.61,"discounted_cash":9.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.25 mg/2 mL suspension for nebulization 2 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487960101","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.25 mg/2 mL suspension for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93681545","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.25 mg/2 mL suspension for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93681573","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.25 mg/2 mL suspension for nebulization 2 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"186198804","type":"NDC"}],"standard_charges":[{"gross_charge":34.61,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 80 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877051490","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 80 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904629304","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 80 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084059095","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 80 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079021101","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 80 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378395377","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 80 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084059025","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 30 MG tablet extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904720861","type":"NDC"}],"standard_charges":[{"gross_charge":4.53,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 30 MG tablet extended release 24hr 50 each","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708006","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.5 mg/2 mL suspension for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93681645","type":"NDC"}],"standard_charges":[{"gross_charge":12.21,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 30 MG tablet extended release 24hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268059711","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487970101","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.5 mg/2 mL suspension for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93681655","type":"NDC"}],"standard_charges":[{"gross_charge":24.07,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone-pramoxine 1-1 % cream 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802014464","type":"NDC"}],"standard_charges":[{"gross_charge":452.09,"discounted_cash":113.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE modified per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"93901865","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE modified per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"93901819","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE modified per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"51862045847","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE modified per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"51862045801","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE modified per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"74310832","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE modified per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"78024661","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % cream with perineal applicator 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"69315031228","type":"NDC"}],"standard_charges":[{"gross_charge":32.1,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % cream with perineal applicator 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"62559043130","type":"NDC"}],"standard_charges":[{"gross_charge":270.65,"discounted_cash":67.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % cream with perineal applicator 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":35.28,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % cream with perineal applicator 28.35 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"10631040701","type":"NDC"}],"standard_charges":[{"gross_charge":110.26,"discounted_cash":27.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin-HC 3.5-10,000-1 mg/mL-unit/mL-% drops,suspension 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":203.53,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin-HC 3.5-10,000-1 mg/mL-unit/mL-% drops,suspension 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314064511","type":"NDC"}],"standard_charges":[{"gross_charge":243.6,"discounted_cash":60.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687052483","type":"NDC"}],"standard_charges":[{"gross_charge":36.46,"discounted_cash":9.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.5 mg/2 mL suspension for nebulization 2 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687052479","type":"NDC"}],"standard_charges":[{"gross_charge":36.46,"discounted_cash":9.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide 0.5 mg/2 mL suspension for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93681619","type":"NDC"}],"standard_charges":[{"gross_charge":24.07,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone-pramoxine 1-1 % foam 10 g Can","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"37682210","type":"NDC"}],"standard_charges":[{"gross_charge":816.48,"discounted_cash":204.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 30 MG tablet extended release 24hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084059711","type":"NDC"}],"standard_charges":[{"gross_charge":4.88,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 30 MG tablet extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762669008","type":"NDC"}],"standard_charges":[{"gross_charge":5.44,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 10-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406012562","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 10-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406012523","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 10-325 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268040215","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 10-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268040211","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 10-325 mg tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746011005","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 10-325 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746011001","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin glargine per 5 Units","drug_information":{"unit":1000.0,"type":"UN"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"88222033","type":"NDC"}],"standard_charges":[{"gross_charge":907.2,"discounted_cash":226.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivastigmine 6 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756014886","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079097820","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084028111","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084028101","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079097801","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fenofibrate 160 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57844069298","type":"NDC"}],"standard_charges":[{"gross_charge":32.1,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"salmeteroL 50 mcg/dose blister with device 60 each BLIST PACK","drug_information":{"unit":0.01667,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"173052100","type":"NDC"}],"standard_charges":[{"gross_charge":28.06,"discounted_cash":7.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"salmeteroL 50 mcg/dose blister with device 28 each BLIST PACK","drug_information":{"unit":0.03571,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"173052000","type":"NDC"}],"standard_charges":[{"gross_charge":33.54,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 10-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041801","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 30 MG tablet extended release 24hr 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268059715","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 10-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041811","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.05 mg/24 hr patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781020604","type":"NDC"}],"standard_charges":[{"gross_charge":61.82,"discounted_cash":15.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ergocalciferol 1,250 mcg (50,000 unit) capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268029715","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ergocalciferol 1,250 mcg (50,000 unit) capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268029711","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ergocalciferol 1,250 mcg (50,000 unit) capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050011","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ergocalciferol 1,250 mcg (50,000 unit) capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050001","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ergocalciferol 1,250 mcg (50,000 unit) capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380073706","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ergocalciferol 1,250 mcg (50,000 unit) capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084046311","type":"NDC"}],"standard_charges":[{"gross_charge":4.77,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.1 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781710458","type":"NDC"}],"standard_charges":[{"gross_charge":62.33,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.1 mg/24 hr patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781710454","type":"NDC"}],"standard_charges":[{"gross_charge":62.33,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.1 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781020911","type":"NDC"}],"standard_charges":[{"gross_charge":80.07,"discounted_cash":20.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.1 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378335216","type":"NDC"}],"standard_charges":[{"gross_charge":66.42,"discounted_cash":16.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.1 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50419045201","type":"NDC"}],"standard_charges":[{"gross_charge":75.83,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.1 mg/24 hr patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781020904","type":"NDC"}],"standard_charges":[{"gross_charge":80.07,"discounted_cash":20.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.05 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781713358","type":"NDC"}],"standard_charges":[{"gross_charge":56.21,"discounted_cash":14.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.05 mg/24 hr patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781713354","type":"NDC"}],"standard_charges":[{"gross_charge":56.21,"discounted_cash":14.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.05 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781020611","type":"NDC"}],"standard_charges":[{"gross_charge":61.82,"discounted_cash":15.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 10-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904682561","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 5 mg/gram (0.5 %) ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"17478007031","type":"NDC"}],"standard_charges":[{"gross_charge":16.46,"discounted_cash":4.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 5 mg/gram (0.5 %) ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"17478082401","type":"NDC"}],"standard_charges":[{"gross_charge":39.48,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 5 mg/gram (0.5 %) ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574402435","type":"NDC"}],"standard_charges":[{"gross_charge":59.73,"discounted_cash":14.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 20 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111025660","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 20 MG capsule 40 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904626908","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.65 % aerosol,spray 44 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"96295013160","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.65 % aerosol,spray 44 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904386575","type":"NDC"}],"standard_charges":[{"gross_charge":4.44,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estrogens (conjugated) 1.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46110481","type":"NDC"}],"standard_charges":[{"gross_charge":28.11,"discounted_cash":7.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem Extended Release 240 MG capsule,ext release degradable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505001606","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem Extended Release 240 MG capsule,ext release degradable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378534001","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem Extended Release 180 MG capsule,ext release degradable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505001506","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem Extended Release 120 MG capsule,ext release degradable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505001406","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710219605","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 470 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"59762505007","type":"NDC"}],"standard_charges":[{"gross_charge":390.85,"discounted_cash":97.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 470 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"59762505001","type":"NDC"}],"standard_charges":[{"gross_charge":191.48,"discounted_cash":47.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213805","type":"NDC"}],"standard_charges":[{"gross_charge":6.62,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 470 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42192060816","type":"NDC"}],"standard_charges":[{"gross_charge":321.76,"discounted_cash":80.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65162069890","type":"NDC"}],"standard_charges":[{"gross_charge":359.57,"discounted_cash":89.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 20 MG capsule 80 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084010309","type":"NDC"}],"standard_charges":[{"gross_charge":12.72,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 470 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"59762502501","type":"NDC"}],"standard_charges":[{"gross_charge":185.56,"discounted_cash":46.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 20 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084010311","type":"NDC"}],"standard_charges":[{"gross_charge":12.72,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 20 MG capsule 80 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904626945","type":"NDC"}],"standard_charges":[{"gross_charge":10.07,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687039011","type":"NDC"}],"standard_charges":[{"gross_charge":3.76,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687039001","type":"NDC"}],"standard_charges":[{"gross_charge":3.76,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268054015","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268054011","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904632261","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079016920","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079016901","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 80 MG capsule 80 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904627245","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 80 MG capsule 40 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739050832","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 80 MG capsule 40 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904627208","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 40 MG capsule 80 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49397041","type":"NDC"}],"standard_charges":[{"gross_charge":51.44,"discounted_cash":12.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 40 MG capsule 80 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904627045","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 40 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084010411","type":"NDC"}],"standard_charges":[{"gross_charge":12.76,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 40 MG capsule 80 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084010409","type":"NDC"}],"standard_charges":[{"gross_charge":12.76,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 40 MG capsule 40 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904627008","type":"NDC"}],"standard_charges":[{"gross_charge":5.61,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone 20 MG capsule 40 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739098832","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 470 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383031147","type":"NDC"}],"standard_charges":[{"gross_charge":90.8,"discounted_cash":22.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alendronate 70 MG tablet 4 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097022416","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN XR 500 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904579461","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084097501","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094000561","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094000559","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406851523","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084018411","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin base 250 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668060630","type":"NDC"}],"standard_charges":[{"gross_charge":21.76,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin base 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238148401","type":"NDC"}],"standard_charges":[{"gross_charge":43.23,"discounted_cash":10.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin base 250 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338010203","type":"NDC"}],"standard_charges":[{"gross_charge":23.71,"discounted_cash":5.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin base 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338010213","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 5 mg/gram (0.5 %) ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"gross_charge":56.7,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 5 mg/gram (0.5 %) ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24208091019","type":"NDC"}],"standard_charges":[{"gross_charge":38.69,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 5 mg/gram (0.5 %) ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"17478007035","type":"NDC"}],"standard_charges":[{"gross_charge":25.42,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 5 mg/gram (0.5 %) ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"72485067031","type":"NDC"}],"standard_charges":[{"gross_charge":26.7,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 5 mg/gram (0.5 %) ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574402450","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 5 mg/gram (0.5 %) ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574402411","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084097511","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 30 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406853001","type":"NDC"}],"standard_charges":[{"gross_charge":2.93,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 30 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084018511","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 30 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858000501","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin ethylsuccinate 200 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220205","type":"NDC"}],"standard_charges":[{"gross_charge":42.15,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin ethylsuccinate 200 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69238150301","type":"NDC"}],"standard_charges":[{"gross_charge":845.04,"discounted_cash":211.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin ethylsuccinate 200 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710214905","type":"NDC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":19.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin ethylsuccinate 200 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62559063001","type":"NDC"}],"standard_charges":[{"gross_charge":810.6,"discounted_cash":202.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin ethylsuccinate 200 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710212905","type":"NDC"}],"standard_charges":[{"gross_charge":63.21,"discounted_cash":15.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin ethylsuccinate 200 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62559044001","type":"NDC"}],"standard_charges":[{"gross_charge":1264.2,"discounted_cash":316.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin ethylsuccinate 200 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710203105","type":"NDC"}],"standard_charges":[{"gross_charge":47.8,"discounted_cash":11.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zanamivir 5 mg/actuation blister with device 20 each Box","drug_information":{"unit":0.05,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"173068101","type":"NDC"}],"standard_charges":[{"gross_charge":21.18,"discounted_cash":5.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin ethylsuccinate 200 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24338013213","type":"NDC"}],"standard_charges":[{"gross_charge":957.18,"discounted_cash":239.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levoFLOXacin 750 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084048311","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lopinavir-ritonavir 400-100 mg/5 mL solution 160 mL Bottle","drug_information":{"unit":0.03125,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"74395646","type":"NDC"}],"standard_charges":[{"gross_charge":65.52,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lopinavir-ritonavir 400-100 mg/5 mL solution 5 mL","drug_information":{"unit":0.03125,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216005","type":"NDC"}],"standard_charges":[{"gross_charge":62.22,"discounted_cash":15.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin 333 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338012413","type":"NDC"}],"standard_charges":[{"gross_charge":34.23,"discounted_cash":8.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 30 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386043101","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 30 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406853023","type":"NDC"}],"standard_charges":[{"gross_charge":6.87,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 30 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162005110","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levoFLOXacin 750 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904635361","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid 600 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877041933","type":"NDC"}],"standard_charges":[{"gross_charge":14.67,"discounted_cash":3.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid 600 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904655304","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid 600 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462029111","type":"NDC"}],"standard_charges":[{"gross_charge":29.38,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 37.5 MG capsule,extended release 24hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862052730","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron ODT 4 MG tablet,disintegrating 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237007730","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron ODT 4 MG tablet,disintegrating 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237007710","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron ODT 4 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462015740","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron ODT 4 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756024060","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron ODT 4 MG tablet,disintegrating 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862039010","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron ODT 4 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781523806","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron ODT 4 MG tablet,disintegrating 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378773293","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 24 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10019055302","type":"NDC"}],"standard_charges":[{"gross_charge":82.52,"discounted_cash":20.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742050501","type":"NDC"}],"standard_charges":[{"gross_charge":34.94,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 24 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742050524","type":"NDC"}],"standard_charges":[{"gross_charge":33.05,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 10 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742050510","type":"NDC"}],"standard_charges":[{"gross_charge":32.29,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 24 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802058062","type":"NDC"}],"standard_charges":[{"gross_charge":38.65,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802058001","type":"NDC"}],"standard_charges":[{"gross_charge":37.11,"discounted_cash":9.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758020854","type":"NDC"}],"standard_charges":[{"gross_charge":75.4,"discounted_cash":18.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 37.5 MG capsule,extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084069801","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10019055390","type":"NDC"}],"standard_charges":[{"gross_charge":74.39,"discounted_cash":18.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 37.5 MG capsule,extended release 24hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084069811","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 37.5 MG capsule,extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904748761","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 7 mg/24 hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598044671","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 7 mg/24 hr patch 24 hour 14 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48985000155","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 7 mg/24 hr patch 24 hour 14 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598044674","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 7 mg/24 hr patch 24 hour 14 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536589488","type":"NDC"}],"standard_charges":[{"gross_charge":7.52,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 150 MG capsule,extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904707661","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 150 MG capsule,extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904647061","type":"NDC"}],"standard_charges":[{"gross_charge":2.09,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 150 MG capsule,extended release 24hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084071311","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 150 MG capsule,extended release 24hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862069730","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 150 MG capsule,extended release 24hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93738698","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 75 MG capsule,extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904707761","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 75 MG capsule,extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904646961","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 75 MG capsule,extended release 24hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084070911","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 75 MG capsule,extended release 24hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382003506","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 75 MG capsule,extended release 24hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862052890","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 75 MG capsule,extended release 24hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862052830","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine XR 37.5 MG capsule,extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904707561","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67434509","type":"NDC"}],"standard_charges":[{"gross_charge":69.08,"discounted_cash":17.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"scopolamine 1 mg over 3 days patch 3 day 10 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10019055388","type":"NDC"}],"standard_charges":[{"gross_charge":74.35,"discounted_cash":18.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omeprazole 20 MG capsule,delayed release(DR/EC) 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268065615","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 60 MG tablet extended release 24hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084059811","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 60 MG tablet extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762669108","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin-dipyridamole 25-200 mg capsule, ER multiphase 12 hr 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904705699","type":"NDC"}],"standard_charges":[{"gross_charge":35.05,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin-dipyridamole 25-200 mg capsule, ER multiphase 12 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462040560","type":"NDC"}],"standard_charges":[{"gross_charge":8.26,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin-dipyridamole 25-200 mg capsule, ER multiphase 12 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162059606","type":"NDC"}],"standard_charges":[{"gross_charge":4.33,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex sprinkle 125 mg capsule, delayed rel sprinkle 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904661561","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex sprinkle 125 mg capsule, delayed rel sprinkle 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268025813","type":"NDC"}],"standard_charges":[{"gross_charge":3.66,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex sprinkle 125 mg capsule, delayed rel sprinkle 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268025811","type":"NDC"}],"standard_charges":[{"gross_charge":3.66,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex sprinkle 125 mg capsule, delayed rel sprinkle 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382010601","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine 0.3 mg/24 hr patch weekly 4 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817061204","type":"NDC"}],"standard_charges":[{"gross_charge":75.02,"discounted_cash":18.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine 0.3 mg/24 hr patch weekly 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378087316","type":"NDC"}],"standard_charges":[{"gross_charge":324.9,"discounted_cash":81.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine 0.2 mg/24 hr patch weekly 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378087216","type":"NDC"}],"standard_charges":[{"gross_charge":234.19,"discounted_cash":58.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine 0.2 mg/24 hr patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378087299","type":"NDC"}],"standard_charges":[{"gross_charge":234.19,"discounted_cash":58.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine 0.1 mg/24 hr patch weekly 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378087116","type":"NDC"}],"standard_charges":[{"gross_charge":139.1,"discounted_cash":34.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine 0.1 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591350854","type":"NDC"}],"standard_charges":[{"gross_charge":102.39,"discounted_cash":25.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 60 MG tablet extended release 24hr 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708106","type":"NDC"}],"standard_charges":[{"gross_charge":6.76,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 60 MG tablet extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708161","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 90 MG tablet extended release 24hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762669208","type":"NDC"}],"standard_charges":[{"gross_charge":10.78,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 90 MG tablet extended release 24hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079089701","type":"NDC"}],"standard_charges":[{"gross_charge":8.72,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omeprazole 20 MG capsule,delayed release(DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268065611","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omeprazole 20 MG capsule,delayed release(DR/EC) 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781286831","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omeprazole 20 MG capsule,delayed release(DR/EC) 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781279031","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omeprazole 20 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084012801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omeprazole 20 MG capsule,delayed release(DR/EC) 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505006500","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omeprazole 20 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904568461","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 1 mg strip 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51801000940","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 14 mg/24 hr patch 24 hour 14 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536589588","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 1 mg strip 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51801000901","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 1 mg strip 300 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17238090030","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 1 mg strip 100 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17238090011","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 1 mg strip 100 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478040401","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminosalicylic acid 4 gram granules DR for susp in packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49938010704","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 90 MG tablet extended release 24hr 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708204","type":"NDC"}],"standard_charges":[{"gross_charge":11.72,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 90 MG tablet extended release 24hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979000901","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine XL 90 MG tablet extended release 24hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084060311","type":"NDC"}],"standard_charges":[{"gross_charge":13.36,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 1 mg strip 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17238090099","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45963070911","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 14 mg/24 hr patch 24 hour 14 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598044774","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 14 mg/24 hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598044771","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746030632","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505327500","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884032055","type":"NDC"}],"standard_charges":[{"gross_charge":4.34,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884032052","type":"NDC"}],"standard_charges":[{"gross_charge":4.34,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calamine-zinc oxide 8-8 % lotion 177 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904253321","type":"NDC"}],"standard_charges":[{"gross_charge":7.43,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calamine-zinc oxide 8-8 % lotion 177 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"395041396","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 20-0.5 % aerosol 85 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"16864068003","type":"NDC"}],"standard_charges":[{"gross_charge":22.13,"discounted_cash":5.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 20-0.5 % aerosol 78 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"16864068001","type":"NDC"}],"standard_charges":[{"gross_charge":29.81,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 20-0.5 % aerosol 78 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51409000722","type":"NDC"}],"standard_charges":[{"gross_charge":21.62,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gelatin adsorbable film 6 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9029703","type":"NDC"}],"standard_charges":[{"gross_charge":1898.98,"discounted_cash":474.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 20 mg/mL concentrate 60 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"59762006701","type":"NDC"}],"standard_charges":[{"gross_charge":218.48,"discounted_cash":54.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyvinyl alcohol 1.4 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54799090415","type":"NDC"}],"standard_charges":[{"gross_charge":30.05,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyvinyl alcohol 1.4 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478006012","type":"NDC"}],"standard_charges":[{"gross_charge":24.89,"discounted_cash":6.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyvinyl alcohol 1.4 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536140894","type":"NDC"}],"standard_charges":[{"gross_charge":22.43,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyvinyl alcohol 1.4 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536132594","type":"NDC"}],"standard_charges":[{"gross_charge":21.23,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111026279","type":"NDC"}],"standard_charges":[{"gross_charge":9.86,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyvinyl alcohol 1.4 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904501735","type":"NDC"}],"standard_charges":[{"gross_charge":6.49,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268061511","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342008307","type":"NDC"}],"standard_charges":[{"gross_charge":2.03,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid 600 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877041984","type":"NDC"}],"standard_charges":[{"gross_charge":14.67,"discounted_cash":3.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid 600 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9513803","type":"NDC"}],"standard_charges":[{"gross_charge":23.64,"discounted_cash":5.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid 600 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93824419","type":"NDC"}],"standard_charges":[{"gross_charge":42.64,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid 600 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9513503","type":"NDC"}],"standard_charges":[{"gross_charge":364.2,"discounted_cash":91.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"peppermint spirit spirit 30 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"395224391","type":"NDC"}],"standard_charges":[{"gross_charge":62.51,"discounted_cash":15.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % adhesive patch,medicated 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591352511","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 10 MG tablet,disintegrating 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342008407","type":"NDC"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 10 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746030712","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 10 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111026379","type":"NDC"}],"standard_charges":[{"gross_charge":14.02,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 10 MG tablet,disintegrating 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746030732","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 10 MG tablet,disintegrating 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505327600","type":"NDC"}],"standard_charges":[{"gross_charge":11.24,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 10 MG tablet,disintegrating 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884032155","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 10 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884032152","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380017202","type":"NDC"}],"standard_charges":[{"gross_charge":4.34,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380017201","type":"NDC"}],"standard_charges":[{"gross_charge":4.34,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine zydis 5 MG tablet,disintegrating 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746030612","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"artificial tears(hypromellose) 0.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65004872","type":"NDC"}],"standard_charges":[{"gross_charge":149.12,"discounted_cash":37.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"artificial tears(hypromellose) 0.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"998040815","type":"NDC"}],"standard_charges":[{"gross_charge":142.07,"discounted_cash":35.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 100 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708402","type":"NDC"}],"standard_charges":[{"gross_charge":36.3,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 50 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505700700","type":"NDC"}],"standard_charges":[{"gross_charge":15.02,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 50 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406905076","type":"NDC"}],"standard_charges":[{"gross_charge":21.67,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 50 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378912216","type":"NDC"}],"standard_charges":[{"gross_charge":50.53,"discounted_cash":12.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 25 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708102","type":"NDC"}],"standard_charges":[{"gross_charge":28.28,"discounted_cash":7.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 25 mcg/hr patch 72 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708100","type":"NDC"}],"standard_charges":[{"gross_charge":28.28,"discounted_cash":7.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 25 mcg/hr patch 72 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781042411","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 25 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781042447","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":11.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 25 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505700600","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 25 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378912116","type":"NDC"}],"standard_charges":[{"gross_charge":28.45,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 21 mg/24 hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598044871","type":"NDC"}],"standard_charges":[{"gross_charge":6.26,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 21 mg/24 hr patch 24 hour 14 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536110888","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 21 mg/24 hr patch 24 hour 28 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48985000153","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 21 mg/24 hr patch 24 hour 28 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598044828","type":"NDC"}],"standard_charges":[{"gross_charge":6.26,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 21 mg/24 hr patch 24 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536589633","type":"NDC"}],"standard_charges":[{"gross_charge":6.33,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 21 mg/24 hr patch 24 hour 14 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536589688","type":"NDC"}],"standard_charges":[{"gross_charge":6.33,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 50 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781042647","type":"NDC"}],"standard_charges":[{"gross_charge":64.89,"discounted_cash":16.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 50 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781042611","type":"NDC"}],"standard_charges":[{"gross_charge":64.89,"discounted_cash":16.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 50 mcg/hr patch 72 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708200","type":"NDC"}],"standard_charges":[{"gross_charge":16.77,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 50 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708202","type":"NDC"}],"standard_charges":[{"gross_charge":16.77,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 100 mcg/hr patch 72 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708400","type":"NDC"}],"standard_charges":[{"gross_charge":36.3,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 100 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781042811","type":"NDC"}],"standard_charges":[{"gross_charge":141.2,"discounted_cash":35.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 100 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781042847","type":"NDC"}],"standard_charges":[{"gross_charge":141.2,"discounted_cash":35.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 100 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505700902","type":"NDC"}],"standard_charges":[{"gross_charge":34.97,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 100 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505700900","type":"NDC"}],"standard_charges":[{"gross_charge":34.97,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 100 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406900076","type":"NDC"}],"standard_charges":[{"gross_charge":46.96,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 100 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378912416","type":"NDC"}],"standard_charges":[{"gross_charge":109.96,"discounted_cash":27.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine 14 mg/24 hr patch 24 hour 14 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536110788","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 100 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591321454","type":"NDC"}],"standard_charges":[{"gross_charge":40.32,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 75 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708302","type":"NDC"}],"standard_charges":[{"gross_charge":76.59,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 75 mcg/hr patch 72 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708300","type":"NDC"}],"standard_charges":[{"gross_charge":76.59,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 75 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781042747","type":"NDC"}],"standard_charges":[{"gross_charge":102.57,"discounted_cash":25.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 75 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505700800","type":"NDC"}],"standard_charges":[{"gross_charge":25.69,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 75 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406907576","type":"NDC"}],"standard_charges":[{"gross_charge":39.55,"discounted_cash":9.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 75 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378912316","type":"NDC"}],"standard_charges":[{"gross_charge":79.88,"discounted_cash":19.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 75 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591321354","type":"NDC"}],"standard_charges":[{"gross_charge":30.49,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 75 mcg/hr patch 72 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742055401","type":"NDC"}],"standard_charges":[{"gross_charge":52.74,"discounted_cash":13.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904632206","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877059001","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 25 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436020201","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin 0.1 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802005635","type":"NDC"}],"standard_charges":[{"gross_charge":154.29,"discounted_cash":38.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin 0.1 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"713068315","type":"NDC"}],"standard_charges":[{"gross_charge":43.66,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ezetimibe 10 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228037990","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ezetimibe 10 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228037930","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ezetimibe 10 mg tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268029812","type":"NDC"}],"standard_charges":[{"gross_charge":20.99,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ezetimibe 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268029811","type":"NDC"}],"standard_charges":[{"gross_charge":20.99,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ezetimibe 10 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877049030","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ezetimibe 10 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238115403","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ezetimibe 10 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781569031","type":"NDC"}],"standard_charges":[{"gross_charge":2.88,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dutasteride 0.5 mg capsule 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722013130","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamiVUDine 300 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342000207","type":"NDC"}],"standard_charges":[{"gross_charge":5.58,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gemfibrozil 600 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687022411","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gemfibrozil 600 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097082103","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gemfibrozil 600 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268035015","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gemfibrozil 600 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268035011","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin 0.1 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"713068215","type":"NDC"}],"standard_charges":[{"gross_charge":64.39,"discounted_cash":16.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074615","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin 0.1 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"52565009015","type":"NDC"}],"standard_charges":[{"gross_charge":80.33,"discounted_cash":20.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478028310","type":"NDC"}],"standard_charges":[{"gross_charge":80.51,"discounted_cash":20.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 15 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162089903","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 15 MG tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268009012","type":"NDC"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268009011","type":"NDC"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 15 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505267503","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148000835","type":"NDC"}],"standard_charges":[{"gross_charge":118.44,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904651106","type":"NDC"}],"standard_charges":[{"gross_charge":17.59,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 10 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547030403","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 10 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598055630","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 10 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162089803","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268008915","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268008911","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 10 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505267403","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60758018805","type":"NDC"}],"standard_charges":[{"gross_charge":17.01,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208058060","type":"NDC"}],"standard_charges":[{"gross_charge":139.48,"discounted_cash":34.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin 0.1 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802004635","type":"NDC"}],"standard_charges":[{"gross_charge":157.63,"discounted_cash":39.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074611","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687061211","type":"NDC"}],"standard_charges":[{"gross_charge":5.32,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342006207","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 875-125 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781185201","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 875-125 mg tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571016242","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 875-125 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571016201","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 875-125 mg tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862050320","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 875-125 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862050301","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 875-125 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66685100101","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 500-125 mg tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93227434","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 500-125 mg tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66685100200","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 200 MG tablet sustained-release 12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228017601","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 200 MG tablet sustained-release 12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436006001","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 200 MG tablet sustained-release 12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547029010","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 200 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904702404","type":"NDC"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 200 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687027311","type":"NDC"}],"standard_charges":[{"gross_charge":116.23,"discounted_cash":29.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 200 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241006303","type":"NDC"}],"standard_charges":[{"gross_charge":12.41,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 200 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462057330","type":"NDC"}],"standard_charges":[{"gross_charge":49.38,"discounted_cash":12.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 875-125 mg tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66685100100","type":"NDC"}],"standard_charges":[{"gross_charge":8.03,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 875-125 mg tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93227534","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 400-57 mg/5 mL suspension for reconstitution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"143998250","type":"NDC"}],"standard_charges":[{"gross_charge":44.1,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 400-57 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862053401","type":"NDC"}],"standard_charges":[{"gross_charge":25.62,"discounted_cash":6.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268078315","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268078311","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547036703","type":"NDC"}],"standard_charges":[{"gross_charge":2.09,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378580793","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862057030","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746036030","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 40 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78042315","type":"NDC"}],"standard_charges":[{"gross_charge":32.51,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 15 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598096830","type":"NDC"}],"standard_charges":[{"gross_charge":3.73,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"escitalopram 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547028110","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"escitalopram 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084061711","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"escitalopram 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079054301","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 400-57 mg/5 mL suspension for reconstitution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66685101200","type":"NDC"}],"standard_charges":[{"gross_charge":43.05,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 400-57 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710212205","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 400-57 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710211205","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 400-57 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201205","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 400-57 mg/5 mL suspension for reconstitution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862053450","type":"NDC"}],"standard_charges":[{"gross_charge":28.77,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"escitalopram 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904642661","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 200 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904647104","type":"NDC"}],"standard_charges":[{"gross_charge":52.89,"discounted_cash":13.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148000935","type":"NDC"}],"standard_charges":[{"gross_charge":118.36,"discounted_cash":29.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 20 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162090103","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg tablet, sublingual 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268014415","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg tablet, sublingual 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268014411","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg tablet, sublingual 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54018813","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg tablet, sublingual 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228315403","type":"NDC"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 8 mg tablet, sublingual 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268012915","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 8 mg tablet, sublingual 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268012911","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 8 mg tablet, sublingual 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904715504","type":"NDC"}],"standard_charges":[{"gross_charge":15.01,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 8 mg tablet, sublingual 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049221","type":"NDC"}],"standard_charges":[{"gross_charge":16.51,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 8 mg tablet, sublingual 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049211","type":"NDC"}],"standard_charges":[{"gross_charge":16.51,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 8 mg tablet, sublingual 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54017713","type":"NDC"}],"standard_charges":[{"gross_charge":5.52,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 2 mg tablet, sublingual 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904715404","type":"NDC"}],"standard_charges":[{"gross_charge":8.62,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 2 mg tablet, sublingual 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687048121","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 2 mg tablet, sublingual 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687048111","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCL 2 mg tablet, sublingual 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54017613","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitazoxanide 100 mg/5 mL suspension for reconstitution 60 mL Bottle","drug_information":{"unit":0.08333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"27437010601","type":"NDC"}],"standard_charges":[{"gross_charge":190.01,"discounted_cash":47.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg tablet, sublingual 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687062611","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eletriptan 40 MG tablet 6 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49234045","type":"NDC"}],"standard_charges":[{"gross_charge":576.62,"discounted_cash":144.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg tablet, sublingual 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687062665","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 8-2 mg tablet, sublingual 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383028793","type":"NDC"}],"standard_charges":[{"gross_charge":6.64,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 20 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462026390","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268070915","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268070911","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904677961","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 10 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205000390","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687024511","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687024501","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 10 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462026290","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glyBURIDE 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93936401","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glyBURIDE 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93834401","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glyBURIDE 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079087301","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glyBURIDE 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155005801","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glyBURIDE 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739011910","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin-hydrocortisone 3.5-10,000-1 mg/mL-unit/mL-% solution 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314064610","type":"NDC"}],"standard_charges":[{"gross_charge":239.86,"discounted_cash":59.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin-hydrocortisone 3.5-10,000-1 mg/mL-unit/mL-% solution 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208063110","type":"NDC"}],"standard_charges":[{"gross_charge":199.84,"discounted_cash":49.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 8-2 mg tablet, sublingual 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54018913","type":"NDC"}],"standard_charges":[{"gross_charge":7.57,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862089678","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":3.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862089610","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":3.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378698285","type":"NDC"}],"standard_charges":[{"gross_charge":47.23,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268040015","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268040011","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162011510","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406012423","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079077801","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 5-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687039611","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 5-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904682461","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 5-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406012362","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 5-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406012323","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 5-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084089511","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 5-325 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268040115","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 5-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268040111","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 5-325 mg tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746010905","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148001035","type":"NDC"}],"standard_charges":[{"gross_charge":163.94,"discounted_cash":40.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 20 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598096930","type":"NDC"}],"standard_charges":[{"gross_charge":4.09,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904682661","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764054311","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":14.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764054330","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":14.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93300819","type":"NDC"}],"standard_charges":[{"gross_charge":47.7,"discounted_cash":11.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378698232","type":"NDC"}],"standard_charges":[{"gross_charge":47.23,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382077277","type":"NDC"}],"standard_charges":[{"gross_charge":25.67,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382077230","type":"NDC"}],"standard_charges":[{"gross_charge":25.67,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93300993","type":"NDC"}],"standard_charges":[{"gross_charge":59.11,"discounted_cash":14.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93300919","type":"NDC"}],"standard_charges":[{"gross_charge":59.11,"discounted_cash":14.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764054430","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":14.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 30 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764054411","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":14.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687020211","type":"NDC"}],"standard_charges":[{"gross_charge":46.39,"discounted_cash":11.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862089578","type":"NDC"}],"standard_charges":[{"gross_charge":25.24,"discounted_cash":6.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598056079","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598056078","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378698188","type":"NDC"}],"standard_charges":[{"gross_charge":47.23,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378698132","type":"NDC"}],"standard_charges":[{"gross_charge":47.23,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382077177","type":"NDC"}],"standard_charges":[{"gross_charge":25.67,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382077130","type":"NDC"}],"standard_charges":[{"gross_charge":25.67,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93300893","type":"NDC"}],"standard_charges":[{"gross_charge":47.7,"discounted_cash":11.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lansoprazole 15 MG tablet,disintegrat, delay rel 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862089510","type":"NDC"}],"standard_charges":[{"gross_charge":25.24,"discounted_cash":6.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.6 mg/hr patch 24 hour 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49730011330","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 200 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739070733","type":"NDC"}],"standard_charges":[{"gross_charge":57.89,"discounted_cash":14.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687029411","type":"NDC"}],"standard_charges":[{"gross_charge":32.06,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 600-42.9 mg/5 mL suspension for reconstitution 125 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862053513","type":"NDC"}],"standard_charges":[{"gross_charge":51.45,"discounted_cash":12.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 300 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079020601","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 300 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687068811","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687068801","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739079610","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904657261","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 300 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584071311","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079020501","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687067711","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687067701","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704161","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739041010","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904657161","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111072901","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"allopurinoL 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584098811","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 600-42.9 mg/5 mL suspension for reconstitution 75 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862053575","type":"NDC"}],"standard_charges":[{"gross_charge":35.91,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 325 (65 FE) MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904759182","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 80 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78035834","type":"NDC"}],"standard_charges":[{"gross_charge":38.67,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 80 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862057190","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687063411","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687063401","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547036909","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378581477","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862057290","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687013911","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687013901","type":"NDC"}],"standard_charges":[{"gross_charge":4.52,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746036290","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51660014290","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78035934","type":"NDC"}],"standard_charges":[{"gross_charge":41.5,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 80 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687062311","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 80 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687062301","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 80 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342006310","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 80 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547036809","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 80 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378581377","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 80 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687012811","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 325 (65 FE) MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904759161","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 325 (65 FE) MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37864076099","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 325 (65 FE) MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645076001","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 100 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904632461","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 100 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111046801","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 100 MG tablet extended release 24 hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378459777","type":"NDC"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436018302","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436018301","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877059101","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45963067611","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687040211","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687040201","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268054115","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268054111","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084066611","type":"NDC"}],"standard_charges":[{"gross_charge":3.42,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904632361","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079017001","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 50 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62037083101","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 100 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041301","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 100 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041311","type":"NDC"}],"standard_charges":[{"gross_charge":4.51,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol succinate XL 100 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45963067711","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valGANciclovir 450 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084096595","type":"NDC"}],"standard_charges":[{"gross_charge":63.37,"discounted_cash":15.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 325 (65 FE) MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904759160","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 325 (65 FE) MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904759060","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 300 mg (60 mg iron)/5 mL liquid 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50268033611","type":"NDC"}],"standard_charges":[{"gross_charge":14.78,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 300 mg (60 mg iron)/5 mL liquid 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50268033624","type":"NDC"}],"standard_charges":[{"gross_charge":14.78,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 300 mg (60 mg iron)/5 mL liquid 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121053005","type":"NDC"}],"standard_charges":[{"gross_charge":13.9,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous gluconate 324 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367016504","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous gluconate 324 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574050811","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074811","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous gluconate 324 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574050801","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084073701","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904608461","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378623101","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valGANciclovir 450 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4003822","type":"NDC"}],"standard_charges":[{"gross_charge":252.26,"discounted_cash":63.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valGANciclovir 450 mg tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679610","type":"NDC"}],"standard_charges":[{"gross_charge":60.56,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valGANciclovir 450 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679604","type":"NDC"}],"standard_charges":[{"gross_charge":131.41,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valGANciclovir 450 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722083260","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084073711","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 50 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687029421","type":"NDC"}],"standard_charges":[{"gross_charge":32.06,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valsartan 160 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074815","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide EC 3 mg capsule, delayed & ext.release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574985510","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378020801","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079079001","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862067801","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904586061","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762372001","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079078901","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687038811","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687038801","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862067701","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 0.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762371901","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 0.25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687037711","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 0.25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687037701","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZolam 0.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862067601","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094011259","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094011261","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547040110","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904722461","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904717761","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54429725","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 50 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904659604","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 50 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241006203","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 50 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93528956","type":"NDC"}],"standard_charges":[{"gross_charge":16.29,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079016401","type":"NDC"}],"standard_charges":[{"gross_charge":32.01,"discounted_cash":8.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amphetamine-dextroamphetamine XR 15 MG capsule,extended release 24hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092038501","type":"NDC"}],"standard_charges":[{"gross_charge":29.32,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amphetamine-dextroamphetamine XR 15 MG capsule,extended release 24hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010003101","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amphetamine-dextroamphetamine XR 15 MG capsule,extended release 24hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115148801","type":"NDC"}],"standard_charges":[{"gross_charge":5.56,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amphetamine-dextroamphetamine XR 15 MG capsule,extended release 24hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228306311","type":"NDC"}],"standard_charges":[{"gross_charge":5.17,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079007301","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54829925","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904717861","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547040210","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378021601","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079007201","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54829725","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980056201","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687068111","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687068101","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657015101","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 10-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084071001","type":"NDC"}],"standard_charges":[{"gross_charge":6.96,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 10-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68308048047","type":"NDC"}],"standard_charges":[{"gross_charge":7.96,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 10-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406052323","type":"NDC"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 10-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406052362","type":"NDC"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmethylphenidate 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78038205","type":"NDC"}],"standard_charges":[{"gross_charge":6.44,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmethylphenidate 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808009301","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmethylphenidate 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808009201","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinolone 0.025 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"713070915","type":"NDC"}],"standard_charges":[{"gross_charge":114.22,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinolone 0.01 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"62559028815","type":"NDC"}],"standard_charges":[{"gross_charge":85.18,"discounted_cash":21.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinolone 0.01 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"52565003115","type":"NDC"}],"standard_charges":[{"gross_charge":115.79,"discounted_cash":28.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinolone 0.01 % cream 60 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"713022360","type":"NDC"}],"standard_charges":[{"gross_charge":436.21,"discounted_cash":109.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinolone 0.01 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"713022315","type":"NDC"}],"standard_charges":[{"gross_charge":146.22,"discounted_cash":36.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tenofovir 300 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958040101","type":"NDC"}],"standard_charges":[{"gross_charge":171.1,"discounted_cash":42.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amphetamine-dextroamphetamine XR 30 MG capsule,extended release 24hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092039101","type":"NDC"}],"standard_charges":[{"gross_charge":29.32,"discounted_cash":7.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amphetamine-dextroamphetamine XR 30 MG capsule,extended release 24hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228306111","type":"NDC"}],"standard_charges":[{"gross_charge":5.17,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 10-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084071011","type":"NDC"}],"standard_charges":[{"gross_charge":6.96,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 10-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904643961","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 10-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904709561","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinonide 0.05 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672138601","type":"NDC"}],"standard_charges":[{"gross_charge":48.76,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135021001","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904658261","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315012701","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11534016501","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739053710","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584089711","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162036110","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"budesonide EC 3 mg capsule, delayed & ext.release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162077810","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.31 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204070011","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.31 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66993002135","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.31 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93414564","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.31 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93414504","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinonide 0.05 % cream 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"93026230","type":"NDC"}],"standard_charges":[{"gross_charge":281.61,"discounted_cash":70.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinonide 0.05 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"93026215","type":"NDC"}],"standard_charges":[{"gross_charge":140.81,"discounted_cash":35.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinonide 0.05 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"69238153405","type":"NDC"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluocinonide 0.05 % cream 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672138602","type":"NDC"}],"standard_charges":[{"gross_charge":78.88,"discounted_cash":19.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.31 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204070001","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687025601","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.6 mg/hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382031101","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.6 mg/hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378911616","type":"NDC"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ofloxacin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208041005","type":"NDC"}],"standard_charges":[{"gross_charge":512.99,"discounted_cash":128.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ofloxacin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60505036301","type":"NDC"}],"standard_charges":[{"gross_charge":96.77,"discounted_cash":24.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin PF per 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"781717184","type":"NDC"}],"standard_charges":[{"gross_charge":256.79,"discounted_cash":64.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin PF per 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93408563","type":"NDC"}],"standard_charges":[{"gross_charge":75.22,"discounted_cash":18.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin PF per 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"78049461","type":"NDC"}],"standard_charges":[{"gross_charge":511.69,"discounted_cash":127.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 75 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877027690","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 75 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228012490","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 75 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55154668307","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 75 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729021815","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 75 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084053611","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 75 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084053601","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 75 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111019690","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 75 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079055701","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 75 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904629461","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904664161","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefdinir 300 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781217660","type":"NDC"}],"standard_charges":[{"gross_charge":2.61,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 200 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268063315","type":"NDC"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefdinir 300 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862017760","type":"NDC"}],"standard_charges":[{"gross_charge":3.42,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefdinir 300 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687069911","type":"NDC"}],"standard_charges":[{"gross_charge":14.66,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 200-40 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862049647","type":"NDC"}],"standard_charges":[{"gross_charge":180.78,"discounted_cash":45.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 5 MG tablet,chewable 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342011107","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 5 MG tablet,chewable 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268057415","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 5 MG tablet,chewable 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268057411","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 5 MG tablet,chewable 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781555531","type":"NDC"}],"standard_charges":[{"gross_charge":2.03,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 5 MG tablet,chewable 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54028913","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 10 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904680806","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904680861","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 10 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300022019","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904652961","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904631061","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084087511","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084087501","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"montelukast 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079022301","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefdinir 300 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687069921","type":"NDC"}],"standard_charges":[{"gross_charge":14.66,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefdinir 300 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877054360","type":"NDC"}],"standard_charges":[{"gross_charge":4.26,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 200-40 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54879000716","type":"NDC"}],"standard_charges":[{"gross_charge":365.53,"discounted_cash":91.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 200 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268063311","type":"NDC"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084053311","type":"NDC"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rOPINIRole 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074411","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rOPINIRole 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547027110","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fexofenadine 60 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904719260","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fexofenadine 60 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111078301","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fexofenadine 60 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904697960","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fexofenadine 60 MG tablet 24 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167413104","type":"NDC"}],"standard_charges":[{"gross_charge":3.69,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fexofenadine 60 MG tablet 24 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167041314","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fexofenadine 60 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079054701","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fexofenadine 60 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802042578","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fexofenadine 60 MG tablet 12 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167413102","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fexofenadine 60 MG tablet 12 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167041312","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"letrozole 2.5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991075933","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"letrozole 2.5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93762056","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 4 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93171601","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 4 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162076510","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rOPINIRole 2 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074415","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739067710","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rOPINIRole 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462025401","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rOPINIRole 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074211","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904664061","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739066510","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084053211","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335090488","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687032711","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904663861","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268063011","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54022020","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877024201","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084053011","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505313001","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904627761","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamiVUDine-zidovudine 150-300 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380070703","type":"NDC"}],"standard_charges":[{"gross_charge":7.13,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamiVUDine-zidovudine 150-300 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702020218","type":"NDC"}],"standard_charges":[{"gross_charge":61.52,"discounted_cash":15.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rOPINIRole 0.5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074215","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rOPINIRole 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547026910","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 200-40 mg/5 mL suspension 20 mL Syringe","drug_information":{"unit":0.04228,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710206908","type":"NDC"}],"standard_charges":[{"gross_charge":15.29,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 200-40 mg/5 mL suspension 20 mL Syringe","drug_information":{"unit":0.04228,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710208908","type":"NDC"}],"standard_charges":[{"gross_charge":31.92,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 200-40 mg/5 mL suspension 20 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121085320","type":"NDC"}],"standard_charges":[{"gross_charge":66.86,"discounted_cash":16.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cromolyn 5.2 mg/spray (4 %) spray,non-aerosol 26 mL SQUEEZ BTL","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"14832001101","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cromolyn 5.2 mg/spray (4 %) spray,non-aerosol 26 mL SQUEEZ BTL","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"57782039726","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide mononitrate 60 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904645061","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide mononitrate 60 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084059211","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide mononitrate 60 MG tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155017801","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079011801","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine 10 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904698761","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687036911","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine 10 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687036901","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"527058601","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378161001","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dibucaine 1 % ointment 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802005003","type":"NDC"}],"standard_charges":[{"gross_charge":14.58,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dibucaine 1 % ointment 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536121195","type":"NDC"}],"standard_charges":[{"gross_charge":13.99,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nevirapine 50 mg/5 mL suspension 240 mL Bottle","drug_information":{"unit":0.08333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862005724","type":"NDC"}],"standard_charges":[{"gross_charge":54.1,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nevirapine 50 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":0.08333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710205305","type":"NDC"}],"standard_charges":[{"gross_charge":48.3,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 mg/15 mL liquid 237 mL Bottle","drug_information":{"unit":0.04114,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904584709","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nevirapine 50 mg/5 mL suspension 240 mL Bottle","drug_information":{"unit":0.08333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"597004724","type":"NDC"}],"standard_charges":[{"gross_charge":63.92,"discounted_cash":15.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 mg/15 mL liquid 237 mL Bottle","drug_information":{"unit":0.04114,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"57896020208","type":"NDC"}],"standard_charges":[{"gross_charge":0.82,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 mg/15 mL liquid 15 mL Cup","drug_information":{"unit":0.06329,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710212707","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 250 mcg (0.25 mg) tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954020210","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 250 mcg (0.25 mg) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59212024956","type":"NDC"}],"standard_charges":[{"gross_charge":54.01,"discounted_cash":13.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 250 mcg (0.25 mg) tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59212024955","type":"NDC"}],"standard_charges":[{"gross_charge":70.05,"discounted_cash":17.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 250 mcg (0.25 mg) tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084068011","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 250 mcg (0.25 mg) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084068001","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 250 mcg (0.25 mg) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904592261","type":"NDC"}],"standard_charges":[{"gross_charge":5.27,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 125 mcg (0.125 mg) tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687085811","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 125 mcg (0.125 mg) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687085801","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 125 mcg (0.125 mg) tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238199101","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 125 mcg (0.125 mg) tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084036611","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 125 mcg (0.125 mg) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084036601","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 125 mcg (0.125 mg) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904592161","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 125 mcg (0.125 mg) tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143124001","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"abacavir 300 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862007360","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 mg/15 mL liquid 15 mL Cup","drug_information":{"unit":0.65,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710222007","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 mg/15 mL liquid 15 mL Cup","drug_information":{"unit":0.0625,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710207707","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079028501","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904588061","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mafenide 50 gram packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079062484","type":"NDC"}],"standard_charges":[{"gross_charge":533.18,"discounted_cash":133.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mafenide 50 gram packet 5 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079062485","type":"NDC"}],"standard_charges":[{"gross_charge":533.18,"discounted_cash":133.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"capecitabine 500 mg tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756081622","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin-pot clavulanate 250-125 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781187431","type":"NDC"}],"standard_charges":[{"gross_charge":7.26,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dorzolamide-timoloL 22.3-6.8 mg/mL drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70069005101","type":"NDC"}],"standard_charges":[{"gross_charge":71.77,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desonide 0.05 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672128001","type":"NDC"}],"standard_charges":[{"gross_charge":99.04,"discounted_cash":24.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desipramine 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742011401","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desipramine 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155058001","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desipramine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155057801","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desipramine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238105301","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desipramine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781521801","type":"NDC"}],"standard_charges":[{"gross_charge":4.49,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desipramine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45963034102","type":"NDC"}],"standard_charges":[{"gross_charge":2.7,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 250 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380091806","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 250 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904689004","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 250 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884041201","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexAMETHasone 0.1 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":191.86,"discounted_cash":47.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % cream 5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24357070106","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % cream 5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24357070105","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"52565012215","type":"NDC"}],"standard_charges":[{"gross_charge":54.43,"discounted_cash":13.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739007310","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"172392660","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079028420","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079028401","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"172392560","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079028620","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079028601","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 4 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121589","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"172392760","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone-proguaniL 250-100 mg tablet 24 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"173067502","type":"NDC"}],"standard_charges":[{"gross_charge":27.3,"discounted_cash":6.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextroamphetamine sulfate 5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24338085103","type":"NDC"}],"standard_charges":[{"gross_charge":57.45,"discounted_cash":14.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextroamphetamine sulfate 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702006501","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextroamphetamine sulfate 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555095202","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextroamphetamine sulfate 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406895801","type":"NDC"}],"standard_charges":[{"gross_charge":9.54,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 40 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904608661","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378623301","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leflunomide 20 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"88216130","type":"NDC"}],"standard_charges":[{"gross_charge":194.65,"discounted_cash":48.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56016801","type":"NDC"}],"standard_charges":[{"gross_charge":9.71,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121501","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dapsone 100 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954013610","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin (vitamin B-12) 1000 MCG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555000600","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin (vitamin B-12) 1000 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333093825","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin (vitamin B-12) 1000 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333093810","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin (vitamin B-12) 1000 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268085511","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 1 mEq/mL solution 4 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710210801","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 mcg/mL suspension 80 mL Bottle","drug_information":{"unit":0.0125,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710210101","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 25mg/ml solution 120 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710210701","type":"NDC"}],"standard_charges":[{"gross_charge":136.08,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 4 mL Vial","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069404","type":"NDC"}],"standard_charges":[{"gross_charge":16.04,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 30 mL Vial","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"517760425","type":"NDC"}],"standard_charges":[{"gross_charge":75.26,"discounted_cash":18.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"},{"gross_charge":137.27,"discounted_cash":34.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 30 mL Vial","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"409330803","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vitamin E 400 UNIT capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10006070034","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vitamin E 400 UNIT capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"79854090020","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vitamin E 400 UNIT capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904027460","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710700602","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin (vitamin B-12) 1000 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904740361","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54629005701","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cleansing enema kit 1 kit KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710700801","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 KIT"}]},{"description":"cleansing enema kit 1 kit KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710701001","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 KIT"}]},{"description":"cyclopentolate 1 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478010002","type":"NDC"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin regular per 5 Units","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"2821501","type":"NDC"}],"standard_charges":[{"gross_charge":59.47,"discounted_cash":14.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323018730","type":"NDC"}],"standard_charges":[{"gross_charge":9.83,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"48433021501","type":"NDC"}],"standard_charges":[{"gross_charge":196.67,"discounted_cash":49.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079064401","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055811","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055801","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571078301","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547040010","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097084607","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739053110","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591565801","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 10 mcg/mL suspension 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710219801","type":"NDC"}],"standard_charges":[{"gross_charge":17.64,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cleansing enema kit 1 kit KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710701101","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 KIT"}]},{"description":"cleansing enema kit 1 kit KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710700901","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 KIT"}]},{"description":"thiamine 100 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094011659","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094011661","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333093425","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 160 mg/5 mL (5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094001561","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 160 mg/5 mL (5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121178100","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 160 mg/5 mL (5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121178105","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"suzetrigine 50 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51167054830","type":"NDC"}],"standard_charges":[{"gross_charge":61.71,"discounted_cash":15.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"itraconazole 10 mg/mL solution 20 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710222608","type":"NDC"}],"standard_charges":[{"gross_charge":97.19,"discounted_cash":24.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"itraconazole 10 mg/mL solution 150 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"31722000631","type":"NDC"}],"standard_charges":[{"gross_charge":742.14,"discounted_cash":185.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904692461","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687023111","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687023101","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 25 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180035109","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"povidone-iodine 5 % solution 30 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65041130","type":"NDC"}],"standard_charges":[{"gross_charge":80.2,"discounted_cash":20.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 0.75 % gel 45 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"115147446","type":"NDC"}],"standard_charges":[{"gross_charge":556.79,"discounted_cash":139.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 0.75 % gel 45 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"713063737","type":"NDC"}],"standard_charges":[{"gross_charge":94.69,"discounted_cash":23.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70512079005","type":"NDC"}],"standard_charges":[{"gross_charge":23.44,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"gross_charge":34.36,"discounted_cash":8.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 160 mg/5 mL (5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094001559","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 160 mg/5 mL (5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094023159","type":"NDC"}],"standard_charges":[{"gross_charge":4.28,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 160 mg/5 mL (5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094023161","type":"NDC"}],"standard_charges":[{"gross_charge":4.28,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 160 mg/5 mL (5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121096605","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333093410","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645090599","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268085111","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"79854020010","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645090501","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37864090599","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine 100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536468001","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate 1 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208073501","type":"NDC"}],"standard_charges":[{"gross_charge":48.3,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"psyllium 3.5 gram powder in packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000074108","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"psyllium 3.5 gram powder in packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"224185582","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"psyllium 3.5 gram powder in packet 1 each Packet","drug_information":{"unit":3.4,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000002410","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"psyllium 3.5 gram powder in packet 44 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000025445","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"psyllium 3.5 gram powder in packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"224185530","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride (1.33 mEq/mL) solution 1 mL Package","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710209301","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 160 mg/5 mL (5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904727870","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 160 mg/5 mL (5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904727841","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"psyllium 3.5 gram powder in packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000002404","type":"NDC"}],"standard_charges":[{"gross_charge":2.45,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079019901","type":"NDC"}],"standard_charges":[{"gross_charge":6.93,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate 1 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208073506","type":"NDC"}],"standard_charges":[{"gross_charge":113.09,"discounted_cash":28.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate 1 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"gross_charge":17.93,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXcarbazepine 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54009820","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"artificial tears(hypromellose) 0.3 % gel 10 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"65806401","type":"NDC"}],"standard_charges":[{"gross_charge":38.09,"discounted_cash":9.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"artificial tears(hypromellose) 0.3 % gel 10 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"65047401","type":"NDC"}],"standard_charges":[{"gross_charge":52.21,"discounted_cash":13.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"artificial tears(hypromellose) 0.3 % gel 10 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"78042947","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"artificial tears(hypromellose) 0.3 % gel 10 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"78042957","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 2.5 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543038090","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292001220","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292001201","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 2.5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342006707","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084052511","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084052501","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505311000","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904628361","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69306030","type":"NDC"}],"standard_charges":[{"gross_charge":9.28,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904735006","type":"NDC"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXcarbazepine 300 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991029301","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687074265","type":"NDC"}],"standard_charges":[{"gross_charge":4.52,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXcarbazepine 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084085301","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXcarbazepine 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904726361","type":"NDC"}],"standard_charges":[{"gross_charge":3.89,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dapsone 100 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781033431","type":"NDC"}],"standard_charges":[{"gross_charge":5.31,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dapsone 100 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49938010130","type":"NDC"}],"standard_charges":[{"gross_charge":12.76,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pentoxifylline 400 mg tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505003306","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pentoxifylline 400 mg tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904544861","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pramipexole 0.25 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382019716","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pramipexole 0.25 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668009290","type":"NDC"}],"standard_charges":[{"gross_charge":0.4,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin 10 mcg/spray (0.1 mL) spray with pump 5 mL AER W/ADAP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69918050105","type":"NDC"}],"standard_charges":[{"gross_charge":515.93,"discounted_cash":128.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin 10 mcg/spray (0.1 mL) spray with pump 5 mL AER W/ADAP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"47335078891","type":"NDC"}],"standard_charges":[{"gross_charge":191.31,"discounted_cash":47.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin 10 mcg/spray (0.1 mL) spray with pump 5 mL AER W/ADAP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60505081500","type":"NDC"}],"standard_charges":[{"gross_charge":347.55,"discounted_cash":86.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084074411","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084074401","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904608561","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citalopram 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378623201","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXcarbazepine 300 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687072211","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXcarbazepine 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687072201","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXcarbazepine 300 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084085311","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687074211","type":"NDC"}],"standard_charges":[{"gross_charge":6.03,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268007411","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69406189","type":"NDC"}],"standard_charges":[{"gross_charge":14.72,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 7.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097015807","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 7.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268052511","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 7.5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268052515","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 15 mg iron (75 mg)/mL syringe 50 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"87074002","type":"NDC"}],"standard_charges":[{"gross_charge":48.51,"discounted_cash":12.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 15 mg iron (75 mg)/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856748004","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 15 mg iron (75 mg)/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856006106","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 15 mg iron (75 mg)/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710219701","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 15 mg iron (75 mg)/mL syringe 50 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"39328055750","type":"NDC"}],"standard_charges":[{"gross_charge":13.65,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 15 mg iron (75 mg)/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213901","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 15 mg iron (75 mg)/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856062804","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 15 mg iron (75 mg)/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856062704","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferrous sulfate 15 mg iron (75 mg)/mL syringe 50 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383062750","type":"NDC"}],"standard_charges":[{"gross_charge":12.39,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"anagrelide 0.5 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668045301","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"anagrelide 0.5 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"172524160","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate 1 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314039603","type":"NDC"}],"standard_charges":[{"gross_charge":65.77,"discounted_cash":16.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 7.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739070110","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 15 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180050201","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 15 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268052615","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268052611","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781808931","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904670861","type":"NDC"}],"standard_charges":[{"gross_charge":5.66,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904670806","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687028211","type":"NDC"}],"standard_charges":[{"gross_charge":4.11,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904640561","type":"NDC"}],"standard_charges":[{"gross_charge":5.62,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268010311","type":"NDC"}],"standard_charges":[{"gross_charge":5.39,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268010315","type":"NDC"}],"standard_charges":[{"gross_charge":5.39,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate 1 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65039602","type":"NDC"}],"standard_charges":[{"gross_charge":132.17,"discounted_cash":33.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904640506","type":"NDC"}],"standard_charges":[{"gross_charge":4.31,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268009811","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268009815","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679096101","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762306003","type":"NDC"}],"standard_charges":[{"gross_charge":7.14,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687019911","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687019901","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meloxicam 15 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097015907","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 250 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180016006","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084096901","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084096911","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650261","type":"NDC"}],"standard_charges":[{"gross_charge":4.22,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 20 MG tablet,delayed release (DR/EC) 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268063615","type":"NDC"}],"standard_charges":[{"gross_charge":3.22,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxepin 10 mg/mL concentrate 120 mL Bottle","drug_information":{"unit":0.00833,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54838051240","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxepin 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079043601","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ivermectin 3 mg tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799080601","type":"NDC"}],"standard_charges":[{"gross_charge":35.64,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ivermectin 3 mg tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6003220","type":"NDC"}],"standard_charges":[{"gross_charge":33.73,"discounted_cash":8.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54629060101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856728101","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904728160","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094005259","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856699901","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904699980","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904699960","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094002561","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094002559","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433010101","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904623561","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856026301","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079005101","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862056090","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG tablet 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489012002","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904043006","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904043004","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268027915","type":"NDC"}],"standard_charges":[{"gross_charge":7.82,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268027911","type":"NDC"}],"standard_charges":[{"gross_charge":7.82,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG tablet 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143211250","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143211205","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG capsule 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143314250","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG capsule 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143314205","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"35573042880","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"35573042851","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 80 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904687045","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904647461","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084081311","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 80 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084081309","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole 40 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739056410","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268026811","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904645859","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904789159","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 30 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904709661","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 30 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237022030","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 30 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729002110","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 30 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781542131","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 30 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079051401","type":"NDC"}],"standard_charges":[{"gross_charge":10.14,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904709061","type":"NDC"}],"standard_charges":[{"gross_charge":4.82,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 15 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237021990","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 15 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93727156","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 15 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729002015","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 15 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729002010","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 15 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781542092","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pioglitazone 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079051301","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904736161","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904635861","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 0.5 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382011314","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 500 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756079888","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 500 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237004801","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 500 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084078211","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 500 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832712401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904728060","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904718361","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904711561","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904699860","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687012911","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687012901","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904645561","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489012005","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904645760","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603015021","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739047810","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802048678","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584068311","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 500 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904686161","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 500 MG tablet,delayed release (DR/EC) 90 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904686190","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 500 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832712489","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904224461","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 0.5 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382011305","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 50-200 mg tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084028211","type":"NDC"}],"standard_charges":[{"gross_charge":4.07,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 50-200 mg tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079092301","type":"NDC"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 40 % gel 37.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574006930","type":"NDC"}],"standard_charges":[{"gross_charge":15.91,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 40 % gel 37.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574007015","type":"NDC"}],"standard_charges":[{"gross_charge":15.59,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 40 % gel 37.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574006915","type":"NDC"}],"standard_charges":[{"gross_charge":15.91,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 40 % gel 37.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574007030","type":"NDC"}],"standard_charges":[{"gross_charge":15.59,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.075 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781713658","type":"NDC"}],"standard_charges":[{"gross_charge":60.52,"discounted_cash":15.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.075 mg/24 hr patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781713654","type":"NDC"}],"standard_charges":[{"gross_charge":60.52,"discounted_cash":15.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.075 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378335116","type":"NDC"}],"standard_charges":[{"gross_charge":66.42,"discounted_cash":16.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.075 mg/24 hr patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781020811","type":"NDC"}],"standard_charges":[{"gross_charge":80.07,"discounted_cash":20.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.075 mg/24 hr patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378335199","type":"NDC"}],"standard_charges":[{"gross_charge":66.42,"discounted_cash":16.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate (laxative) 495 mg/5 gram granules 454 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"37205060243","type":"NDC"}],"standard_charges":[{"gross_charge":6.96,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate (laxative) 495 mg/5 gram granules 454 g Bag","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"70000002101","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niacin 1000 MG tablet extended release 24 hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651002090","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niacin 1000 MG tablet extended release 24 hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162032309","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niacin 1000 MG tablet extended release 24 hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335061381","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niacin 500 MG tablet extended release 24 hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651001890","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dinoprostone 10 mg insert, extended release 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456412363","type":"NDC"}],"standard_charges":[{"gross_charge":1182.05,"discounted_cash":295.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niacin 500 MG tablet extended release 24 hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162032109","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dinoprostone 10 mg insert, extended release 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55566280001","type":"NDC"}],"standard_charges":[{"gross_charge":2061.91,"discounted_cash":515.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.1 mg/hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378910216","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.6 mg/hr patch 24 hour 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378911693","type":"NDC"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.4 mg/hr patch 24 hour 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49730011230","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.4 mg/hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382031001","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.4 mg/hr patch 24 hour 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382031030","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.4 mg/hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378911216","type":"NDC"}],"standard_charges":[{"gross_charge":2.93,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.4 mg/hr patch 24 hour 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378911293","type":"NDC"}],"standard_charges":[{"gross_charge":2.93,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.3 mg/hr patch 24 hour 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"85331535","type":"NDC"}],"standard_charges":[{"gross_charge":20.34,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.3 mg/hr patch 24 hour 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"85331530","type":"NDC"}],"standard_charges":[{"gross_charge":20.34,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.3 mg/hr patch 24 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"85331504","type":"NDC"}],"standard_charges":[{"gross_charge":20.34,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.3 mg/hr patch 24 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"85331503","type":"NDC"}],"standard_charges":[{"gross_charge":20.34,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.2 mg/hr patch 24 hour 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49730011130","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.2 mg/hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382030901","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.2 mg/hr patch 24 hour 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382030930","type":"NDC"}],"standard_charges":[{"gross_charge":3.95,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.2 mg/hr patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378910416","type":"NDC"}],"standard_charges":[{"gross_charge":2.09,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.2 mg/hr patch 24 hour 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378910493","type":"NDC"}],"standard_charges":[{"gross_charge":2.09,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dinoprostone 10 mg insert, extended release 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55566280000","type":"NDC"}],"standard_charges":[{"gross_charge":2061.91,"discounted_cash":515.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niacin 500 MG tablet extended release 24 hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335053981","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 400 mcg/spray spray,non-aerosol 4.9 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"28595012049","type":"NDC"}],"standard_charges":[{"gross_charge":469.9,"discounted_cash":117.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 400 mcg/spray spray,non-aerosol 4.9 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"70003030065","type":"NDC"}],"standard_charges":[{"gross_charge":502.75,"discounted_cash":125.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722053712","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904605261","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180011316","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079082101","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904712361","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"entacapone 200 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78032705","type":"NDC"}],"standard_charges":[{"gross_charge":30.14,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"entacapone 200 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904682207","type":"NDC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"entacapone 200 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904682204","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"entacapone 200 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687018811","type":"NDC"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 75 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205004411","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 75 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332041510","type":"NDC"}],"standard_charges":[{"gross_charge":52.77,"discounted_cash":13.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 75 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180067711","type":"NDC"}],"standard_charges":[{"gross_charge":5.78,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 75 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710101002","type":"NDC"}],"standard_charges":[{"gross_charge":18.91,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 75 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781047013","type":"NDC"}],"standard_charges":[{"gross_charge":53.26,"discounted_cash":13.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 75 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4080085","type":"NDC"}],"standard_charges":[{"gross_charge":61.38,"discounted_cash":15.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084087001","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084087011","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739041110","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904712461","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 400 mcg/spray spray,non-aerosol 4.9 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802021001","type":"NDC"}],"standard_charges":[{"gross_charge":746.37,"discounted_cash":186.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prednisoLONE acetate 0.12 % drops,suspension 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"11980017405","type":"NDC"}],"standard_charges":[{"gross_charge":637.64,"discounted_cash":159.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dofetilide 250 MCG capsule 40 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904668208","type":"NDC"}],"standard_charges":[{"gross_charge":19.35,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dofetilide 250 MCG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205004060","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dofetilide 125 MCG capsule 40 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904668108","type":"NDC"}],"standard_charges":[{"gross_charge":17.82,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dofetilide 125 MCG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205003960","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dofetilide 125 MCG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335006186","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 50-200 mg tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228046101","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dofetilide 125 MCG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862012560","type":"NDC"}],"standard_charges":[{"gross_charge":27.3,"discounted_cash":6.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 750 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739078710","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 750 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904605361","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 750 MG tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722053812","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 750 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079082201","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687065711","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687065701","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 MG tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571078812","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 750 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904712561","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.6 mg/hr patch 24 hour 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382031130","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084027111","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079046101","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.63 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66993002235","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.63 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93414604","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"70377001411","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"904662361","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"68084044911","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"51079081720","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"51079081701","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-benzethonium 20-0.2 % aerosol 78 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51409000724","type":"NDC"}],"standard_charges":[{"gross_charge":20.31,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-benzethonium 20-0.2 % aerosol 99 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"63824082035","type":"NDC"}],"standard_charges":[{"gross_charge":19.54,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-benzethonium 20-0.2 % aerosol 99 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"63824000381","type":"NDC"}],"standard_charges":[{"gross_charge":15.38,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 60 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93031901","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 60 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079074601","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 60 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687072811","type":"NDC"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 60 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687072801","type":"NDC"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 60 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228048201","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.63 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 60 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057311","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.63 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204080011","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.63 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93414656","type":"NDC"}],"standard_charges":[{"gross_charge":4.74,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687039579","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204020060","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204020030","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487950103","type":"NDC"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487950101","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 1.25 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93414856","type":"NDC"}],"standard_charges":[{"gross_charge":5.93,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 1.25 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93414845","type":"NDC"}],"standard_charges":[{"gross_charge":5.93,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 1.25 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204090025","type":"NDC"}],"standard_charges":[{"gross_charge":4.69,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 1.25 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204090015","type":"NDC"}],"standard_charges":[{"gross_charge":4.69,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 1.25 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204090011","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 1.25 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204090001","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 1.25 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66993002335","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 1.25 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93414804","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.63 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"35573044425","type":"NDC"}],"standard_charges":[{"gross_charge":4.69,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levalbuterol 0.63 mg/3 mL solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93414645","type":"NDC"}],"standard_charges":[{"gross_charge":4.74,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 60 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057301","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 60 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378004501","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 60 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739008010","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268016911","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687044711","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687044701","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097042107","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25152534","type":"NDC"}],"standard_charges":[{"gross_charge":55.45,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084097611","type":"NDC"}],"standard_charges":[{"gross_charge":8.48,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650361","type":"NDC"}],"standard_charges":[{"gross_charge":8.49,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762151701","type":"NDC"}],"standard_charges":[{"gross_charge":7.36,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079021501","type":"NDC"}],"standard_charges":[{"gross_charge":10.06,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72241002305","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268016815","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268016811","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043611","type":"NDC"}],"standard_charges":[{"gross_charge":5.09,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097042207","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25152034","type":"NDC"}],"standard_charges":[{"gross_charge":40.18,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268016915","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"celecoxib 200 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72241002405","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide mononitrate 30 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084059111","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide mononitrate 30 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904644961","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 30 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93031801","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 30 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079074501","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 30 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687071711","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 30 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687071701","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 30 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228048101","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 30 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687056211","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 30 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687056201","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687039583","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 30 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378002305","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"belladonna alkaloids-opium 16.2-60 MG suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574704001","type":"NDC"}],"standard_charges":[{"gross_charge":114.74,"discounted_cash":28.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"belladonna alkaloids-opium 16.2-60 MG suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574704012","type":"NDC"}],"standard_charges":[{"gross_charge":114.74,"discounted_cash":28.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"modafiniL 100 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679104","type":"NDC"}],"standard_charges":[{"gross_charge":22.02,"discounted_cash":5.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"modafiniL 100 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332038530","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"modafiniL 100 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084062121","type":"NDC"}],"standard_charges":[{"gross_charge":24.12,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"modafiniL 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084062111","type":"NDC"}],"standard_charges":[{"gross_charge":24.12,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"modafiniL 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079056101","type":"NDC"}],"standard_charges":[{"gross_charge":42.49,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 30 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739007910","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084027101","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487950100","type":"NDC"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"47335070354","type":"NDC"}],"standard_charges":[{"gross_charge":0.78,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084043099","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 14 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084043098","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079030601","type":"NDC"}],"standard_charges":[{"gross_charge":6.9,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 10 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41100080676","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 14 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574041207","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"disulfiram 250 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781060730","type":"NDC"}],"standard_charges":[{"gross_charge":12.32,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dipyridamole 75 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904108861","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dipyridamole 75 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382018901","type":"NDC"}],"standard_charges":[{"gross_charge":6.56,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dipyridamole 75 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115107201","type":"NDC"}],"standard_charges":[{"gross_charge":4.21,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dipyridamole 75 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980013501","type":"NDC"}],"standard_charges":[{"gross_charge":9.47,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dipyridamole 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904108661","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dipyridamole 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115107001","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dipyridamole 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980013301","type":"NDC"}],"standard_charges":[{"gross_charge":5.97,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenoxylate-atropine 2.5-0.025 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687056911","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenoxylate-atropine 2.5-0.025 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687056901","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904642281","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenoxylate-atropine 2.5-0.025 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406123601","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904642286","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043199","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458059110","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 250 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687086811","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 250 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687086801","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 250 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904686061","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 250 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832712389","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 250 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084077611","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 250 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237004701","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 250 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756079788","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 125 MG tablet,delayed release (DR/EC) 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687021121","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 125 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687021111","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 125 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237004601","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"divalproex 125 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756079688","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043192","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904693181","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904693186","type":"NDC"}],"standard_charges":[{"gross_charge":5.17,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 17 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11523723401","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenoxylate-atropine 2.5-0.025 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315091001","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenoxylate-atropine 2.5-0.025 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25006131","type":"NDC"}],"standard_charges":[{"gross_charge":13.1,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenoxylate-atropine 2.5-0.025 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762106101","type":"NDC"}],"standard_charges":[{"gross_charge":4.08,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084006911","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143992701","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 50 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399102801","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 50 MG capsule 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399802602","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 50 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904530760","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 50 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904205661","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 25 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399102701","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 25 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904723761","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 25 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904723760","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 25 mg capsule 24 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904723724","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 25 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618002401","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 25 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536101001","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 25 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904530661","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 25 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904530660","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 25 mg capsule 24 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580022824","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862007601","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739070010","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687052801","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687052811","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenoxylate-atropine 2.5-0.025 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378041501","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687086011","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651086701","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904724361","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708361","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904637861","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739055910","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg /3 mL (0.083 %) solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"47335070348","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079018220","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862007701","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16252051501","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084007011","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111012705","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111012701","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143992801","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651086601","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079018201","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314012605","type":"NDC"}],"standard_charges":[{"gross_charge":108.19,"discounted_cash":27.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687025611","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904678061","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904648661","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739035010","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 500 MG capsule 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93310953","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 500 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237003101","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 500 MG capsule 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781261305","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 500 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781261301","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 25 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70377011512","type":"NDC"}],"standard_charges":[{"gross_charge":3.51,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 25 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756059088","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 25 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762120701","type":"NDC"}],"standard_charges":[{"gross_charge":4.51,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 25 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862032101","type":"NDC"}],"standard_charges":[{"gross_charge":6.43,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 25 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794001902","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781202001","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % (40 mg/mL) solution 50 mL Bottle","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60432046550","type":"NDC"}],"standard_charges":[{"gross_charge":3.12,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % (40 mg/mL) solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54350547","type":"NDC"}],"standard_charges":[{"gross_charge":159.6,"discounted_cash":39.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % (40 mg/mL) solution 50 mL Bottle","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"51672141103","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180098101","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % (40 mg/mL) solution 50 mL Bottle","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"64679046551","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 20 MG tablet 100 tablet BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687033301","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"lisinopriL 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679961","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 125 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710210205","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 125 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710200805","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 125 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710200705","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 125 mg/5 mL suspension for reconstitution 80 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"143988880","type":"NDC"}],"standard_charges":[{"gross_charge":8.06,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 125 mg/5 mL suspension for reconstitution 150 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"143988815","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 125 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"143988801","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 125 mg/5 mL suspension for reconstitution 150 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"781603955","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 125 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"781603946","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54852725","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 300 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54252725","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 300 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687080611","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687080601","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 300 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722054501","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 150 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54852625","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 150 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54252625","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687033311","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 125 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710215705","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % (40 mg/mL) solution 50 mL Bottle","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121097251","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % (40 mg/mL) solution 50 mL Bottle","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"527600480","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 125 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"527134701","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 125 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079044301","type":"NDC"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74662411","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904695361","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049711","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049701","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238183401","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378180977","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74662490","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60793085401","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079044201","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 75 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74518211","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 75 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180096709","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 75 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904695161","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 75 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687047511","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 125 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687051911","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % (40 mg/mL) solution 50 mL Bottle","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60432046551","type":"NDC"}],"standard_charges":[{"gross_charge":3.12,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 125 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904695561","type":"NDC"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 150 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079044501","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % (40 mg/mL) solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"52565000950","type":"NDC"}],"standard_charges":[{"gross_charge":123.48,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 300 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180097609","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 300 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180097601","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 300 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74714990","type":"NDC"}],"standard_charges":[{"gross_charge":6.58,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 200 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74714811","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 200 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055211","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 200 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055201","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 200 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180097501","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 200 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378181977","type":"NDC"}],"standard_charges":[{"gross_charge":3.38,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 200 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781518992","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 200 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74714890","type":"NDC"}],"standard_charges":[{"gross_charge":7.59,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 150 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74706911","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 150 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904695661","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 150 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687053011","type":"NDC"}],"standard_charges":[{"gross_charge":3.51,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 150 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378181577","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 125 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74706811","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 80 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"781604158","type":"NDC"}],"standard_charges":[{"gross_charge":14.11,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"143988901","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 150 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"143988915","type":"NDC"}],"standard_charges":[{"gross_charge":17.64,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000057501","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000042401","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904678744","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"49580032901","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"96295382433","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904630477","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687064911","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687064901","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687036711","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904600961","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315090601","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904600960","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079038701","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687083111","type":"NDC"}],"standard_charges":[{"gross_charge":4.73,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687083101","type":"NDC"}],"standard_charges":[{"gross_charge":4.73,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"71399788901","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687063811","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69452038998","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70677111101","type":"NDC"}],"standard_charges":[{"gross_charge":14.92,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone 2.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762374001","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone 2.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555087202","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762374202","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone 10 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687010521","type":"NDC"}],"standard_charges":[{"gross_charge":7.63,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687010511","type":"NDC"}],"standard_charges":[{"gross_charge":7.63,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555077902","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium 84 mg tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59016042019","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium 84 mg tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59016042017","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium 84 mg tablet extended release 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59016042016","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium 84 mg tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71321080010","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium 84 mg tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"36765042001","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"37205011038","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000066001","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904741844","type":"NDC"}],"standard_charges":[{"gross_charge":14.92,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"71399005101","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate solution 296 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"46122074038","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687063801","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93342605","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93342601","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084073611","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084073601","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591024001","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 2 mg/mL concentrate 30 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54353244","type":"NDC"}],"standard_charges":[{"gross_charge":80.64,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 2 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710204700","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loperamide 2 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687022911","type":"NDC"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loperamide 2 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687022901","type":"NDC"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loperamide 2 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079069001","type":"NDC"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 80 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93415579","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710218805","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710211105","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 80 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862070780","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.0625,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201105","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.0625,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710200905","type":"NDC"}],"standard_charges":[{"gross_charge":0.99,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amoxicillin 250 mg/5 mL suspension for reconstitution 80 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"143988980","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315090401","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315090405","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315090410","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904600761","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687035511","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687035501","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107008405","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904600861","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315090510","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315090505","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315090501","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 75 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378180577","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084074211","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687082011","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687082001","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687062711","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687062701","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93342501","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687040111","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687040101","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORazepam 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"187006401","type":"NDC"}],"standard_charges":[{"gross_charge":197.44,"discounted_cash":49.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 75 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079044101","type":"NDC"}],"standard_charges":[{"gross_charge":3.61,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 50 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74455211","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 50 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180096609","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 12 mcg/hr patch 72 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781042311","type":"NDC"}],"standard_charges":[{"gross_charge":63.45,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 12 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781042347","type":"NDC"}],"standard_charges":[{"gross_charge":63.45,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 12 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505701000","type":"NDC"}],"standard_charges":[{"gross_charge":12.19,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 12 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406901276","type":"NDC"}],"standard_charges":[{"gross_charge":38.78,"discounted_cash":9.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 12 mcg/hr patch 72 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378911916","type":"NDC"}],"standard_charges":[{"gross_charge":56.96,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 12 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378911998","type":"NDC"}],"standard_charges":[{"gross_charge":56.96,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"entecavir 0.5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991089533","type":"NDC"}],"standard_charges":[{"gross_charge":43.01,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"entecavir 0.5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097042602","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"entecavir 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687021695","type":"NDC"}],"standard_charges":[{"gross_charge":93.78,"discounted_cash":23.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"entecavir 0.5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722083330","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"entecavir 0.5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3161112","type":"NDC"}],"standard_charges":[{"gross_charge":181.87,"discounted_cash":45.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium 17 mcg/actuation HFA aerosol inhaler 12.9 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"597008717","type":"NDC"}],"standard_charges":[{"gross_charge":1219.75,"discounted_cash":304.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycerin (adult) suppository 24 each Jar","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"1320007924","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycerin (adult) suppository 24 each Jar","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"132007924","type":"NDC"}],"standard_charges":[{"gross_charge":0.45,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycerin (adult) suppository 12 each Jar","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"132007912","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 12 mcg/hr patch 72 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708000","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 mg/4 mL solution 120 mL Bottle","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54329450","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 12 mcg/hr patch 72 hour 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505708002","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % ointment 35.44 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168020437","type":"NDC"}],"standard_charges":[{"gross_charge":937.44,"discounted_cash":234.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904667104","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268071715","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268071711","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084086921","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084086911","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93551798","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162035109","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % ointment 35.44 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"70752011303","type":"NDC"}],"standard_charges":[{"gross_charge":35.72,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % ointment 35.44 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"33342040535","type":"NDC"}],"standard_charges":[{"gross_charge":41.98,"discounted_cash":10.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % ointment 35.44 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"42291037935","type":"NDC"}],"standard_charges":[{"gross_charge":189.19,"discounted_cash":47.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % ointment 35.44 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"68462041820","type":"NDC"}],"standard_charges":[{"gross_charge":162.99,"discounted_cash":40.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % ointment 35.44 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"52565000814","type":"NDC"}],"standard_charges":[{"gross_charge":29.17,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % ointment 35.44 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"65162091838","type":"NDC"}],"standard_charges":[{"gross_charge":43.91,"discounted_cash":10.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % ointment 35.44 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672302009","type":"NDC"}],"standard_charges":[{"gross_charge":97.64,"discounted_cash":24.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 % ointment 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"gross_charge":117.18,"discounted_cash":29.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omega-3 acid ethyl esters 1 gram capsule 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505317007","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 mg/4 mL solution 60 mL Bottle","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54329446","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"25021045101","type":"NDC"}],"standard_charges":[{"gross_charge":8.21,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323036501","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703330104","type":"NDC"}],"standard_charges":[{"gross_charge":9.54,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710218305","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"64380016601","type":"NDC"}],"standard_charges":[{"gross_charge":139.06,"discounted_cash":34.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216705","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"16571067516","type":"NDC"}],"standard_charges":[{"gross_charge":182.77,"discounted_cash":45.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710214405","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"13517010716","type":"NDC"}],"standard_charges":[{"gross_charge":353.61,"discounted_cash":88.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 5 mL Syringe","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710209505","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 5 mL Syringe","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710205805","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"603150858","type":"NDC"}],"standard_charges":[{"gross_charge":276.14,"discounted_cash":69.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 30 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"45802041059","type":"NDC"}],"standard_charges":[{"gross_charge":12.35,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 30 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000066501","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 30 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904742730","type":"NDC"}],"standard_charges":[{"gross_charge":9.83,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323036504","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703330101","type":"NDC"}],"standard_charges":[{"gross_charge":9.54,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617401","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617410","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 mg/4 mL solution 4 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710223404","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 mg/4 mL solution 4 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710223304","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide 40 mg/4 mL solution 4 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094075662","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 2 % jelly in applicator 11 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"25021067377","type":"NDC"}],"standard_charges":[{"gross_charge":29.8,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 2 % jelly in applicator 6 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"25021067376","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 10 mcg/mL (400 unit/mL) drops 1 mL Syringe","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710219301","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 10 mcg/mL (400 unit/mL) drops 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856004901","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041611","type":"NDC"}],"standard_charges":[{"gross_charge":4.09,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 10 mcg/mL (400 unit/mL) drops 1 mL Syringe","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710209601","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 10 mcg/mL (400 unit/mL) drops 50 mL DROP BTL","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54838000650","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 10 mcg/mL (400 unit/mL) drops 50 mL DROP BTL","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383091750","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin regular in NS 100 unit/100 mL (1 unit/mL) solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"338012612","type":"NDC"}],"standard_charges":[{"gross_charge":79.38,"discounted_cash":19.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin lispro per 50 Units","drug_information":{"unit":1000.0,"type":"UN"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"2751001","type":"NDC"}],"standard_charges":[{"gross_charge":193.2,"discounted_cash":48.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorothiazide 250 mg/5 mL suspension 237 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65649031112","type":"NDC"}],"standard_charges":[{"gross_charge":273.74,"discounted_cash":68.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 10 mcg/mL (400 unit/mL) drops 1 mL Syringe","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710202401","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meperidine 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806005001","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041621","type":"NDC"}],"standard_charges":[{"gross_charge":4.09,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739007233","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin 5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54449613","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin 5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742018130","type":"NDC"}],"standard_charges":[{"gross_charge":4.49,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin 5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806035830","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079013301","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904741161","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 50 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268003915","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268003911","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904718561","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687044411","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904020261","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 50 mcg/mL (0.05 mg/mL) solution 60 mL Bottle","drug_information":{"unit":0.04167,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689032702","type":"NDC"}],"standard_charges":[{"gross_charge":12.24,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 50 mcg/mL (0.05 mg/mL) solution 2.5 mL Syringe","drug_information":{"unit":0.04167,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710202902","type":"NDC"}],"standard_charges":[{"gross_charge":19.22,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin 50 mcg/mL (0.05 mg/mL) solution 60 mL DROP BTL","drug_information":{"unit":0.04167,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54005746","type":"NDC"}],"standard_charges":[{"gross_charge":20.48,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079010701","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904741061","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin 5 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54449625","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904718461","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin 5 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54849619","type":"NDC"}],"standard_charges":[{"gross_charge":7.74,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079044401","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 50 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904695061","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 50 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687046411","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 50 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687046401","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 50 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378180377","type":"NDC"}],"standard_charges":[{"gross_charge":2.46,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 50 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"527134201","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 50 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079044020","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 50 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079044001","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729044715","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904694961","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687045311","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687045301","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180096501","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378180077","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74434190","type":"NDC"}],"standard_charges":[{"gross_charge":7.59,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 25 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079044420","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin 5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079058101","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043311","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043301","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904020161","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 75 MG capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238131209","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 75 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049511","type":"NDC"}],"standard_charges":[{"gross_charge":3.53,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 75 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049501","type":"NDC"}],"standard_charges":[{"gross_charge":3.53,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 75 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71101441","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 50 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904699261","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 50 MG capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238131109","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 50 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687048411","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 50 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71101341","type":"NDC"}],"standard_charges":[{"gross_charge":44.57,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 25 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904699161","type":"NDC"}],"standard_charges":[{"gross_charge":3.37,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 25 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904699104","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 25 MG capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238131009","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 25 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687047311","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 25 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687047301","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 25 MG capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71101268","type":"NDC"}],"standard_charges":[{"gross_charge":40.61,"discounted_cash":10.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNV no.52-iron-FA-omega-3-dha 29-1-250 mg combo pack 60 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13811001030","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 75 MG capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205001390","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 75 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904700061","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 100 MG capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71101568","type":"NDC"}],"standard_charges":[{"gross_charge":41.23,"discounted_cash":10.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71101541","type":"NDC"}],"standard_charges":[{"gross_charge":45.25,"discounted_cash":11.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lopinavir-ritonavir 200-50 mg tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74679922","type":"NDC"}],"standard_charges":[{"gross_charge":34.95,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079013101","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268003715","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268003711","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571010501","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756020111","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729017101","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sildenafiL (pulm.hypertension) 20 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904667106","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781148601","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loperamide 1 mg/7.5 mL liquid 7.5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856683601","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loperamide 1 mg/7.5 mL liquid 7.5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094002959","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loperamide 1 mg/7.5 mL liquid 7.5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856054502","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loperamide 1 mg/7.5 mL liquid 7.5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856011105","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904700161","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 100 MG capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205001490","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pregabalin 100 MG capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238131309","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amitriptyline 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603221221","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meperidine 50 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806005030","type":"NDC"}],"standard_charges":[{"gross_charge":282.73,"discounted_cash":70.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meperidine 50 mg tablet 25 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54859511","type":"NDC"}],"standard_charges":[{"gross_charge":4.12,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 5 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710204805","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"perphenazine 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084060201","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin v potassium 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143983601","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin v potassium 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781165501","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin v potassium 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862017601","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin v potassium 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237004001","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin v potassium 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781120501","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin v potassium 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862017501","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 5-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687064211","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 5-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687064201","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 5-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904709361","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 5-325 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781019601","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 5-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904643761","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 5-325 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406051223","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 5-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084035511","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 5-325 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406051262","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"perphenazine 4 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084060211","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE-acetaminophen 5-325 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746020301","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"perphenazine 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781104713","type":"NDC"}],"standard_charges":[{"gross_charge":4.87,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"perphenazine 8 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781104813","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 20 mg/5 mL (4 mg/mL) elixir 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"16571033016","type":"NDC"}],"standard_charges":[{"gross_charge":264.22,"discounted_cash":66.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenazopyridine 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367061201","type":"NDC"}],"standard_charges":[{"gross_charge":5.69,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenazopyridine 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162068210","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenazopyridine 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367016304","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenazopyridine 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75826011510","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenazopyridine 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293081101","type":"NDC"}],"standard_charges":[{"gross_charge":10.98,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenazopyridine 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192080201","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenazopyridine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162068110","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenazopyridine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75826011410","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenazopyridine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293081001","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"perphenazine 8 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084060711","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxybutynin 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904702761","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxybutynin 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155081001","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxybutynin 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832003889","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 60 mL Bottle","drug_information":{"unit":0.08333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69315050460","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 473 mL Bottle","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69315050447","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904727641","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 473 mL Bottle","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121086816","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121086805","type":"NDC"}],"standard_charges":[{"gross_charge":7.08,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 473 mL Bottle","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121081016","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121481040","type":"NDC"}],"standard_charges":[{"gross_charge":4.87,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121481005","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121481000","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 480 mL Bottle","drug_information":{"unit":0.01042,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689000816","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689003701","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121478505","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094059959","type":"NDC"}],"standard_charges":[{"gross_charge":3.38,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802004835","type":"NDC"}],"standard_charges":[{"gross_charge":54.12,"discounted_cash":13.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"713068615","type":"NDC"}],"standard_charges":[{"gross_charge":20.22,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 473 mL Bottle","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121104516","type":"NDC"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710221405","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/mL suspension 473 mL Bottle","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60432053716","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 500,000 unit tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155005101","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxybutynin 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832003801","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxybutynin 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954000510","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxybutynin 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55154722507","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxybutynin 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904282161","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxybutynin 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084040011","type":"NDC"}],"standard_charges":[{"gross_charge":2.57,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxazepam 15 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584081311","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxazepam 15 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228206910","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxazepam 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584081211","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin-triamcinolone 100,000-0.1 unit/gram-% ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672127201","type":"NDC"}],"standard_charges":[{"gross_charge":209.54,"discounted_cash":52.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin-triamcinolone 100,000-0.1 unit/gram-% ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"62332058515","type":"NDC"}],"standard_charges":[{"gross_charge":20.79,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin-triamcinolone 100,000-0.1 unit/gram-% ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802024414","type":"NDC"}],"standard_charges":[{"gross_charge":60.92,"discounted_cash":15.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin-triamcinolone 100,000-0.1 unit/gram-% ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"68462079917","type":"NDC"}],"standard_charges":[{"gross_charge":49.08,"discounted_cash":12.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin-triamcinolone 100,000-0.1 unit/g-% cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672126301","type":"NDC"}],"standard_charges":[{"gross_charge":81.84,"discounted_cash":20.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin-triamcinolone 100,000-0.1 unit/g-% cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802088014","type":"NDC"}],"standard_charges":[{"gross_charge":46.81,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin-triamcinolone 100,000-0.1 unit/g-% cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"68462031417","type":"NDC"}],"standard_charges":[{"gross_charge":52.35,"discounted_cash":13.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxazepam 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228206710","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168000715","type":"NDC"}],"standard_charges":[{"gross_charge":71.69,"discounted_cash":17.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"povidone-iodine 10 % ointment 28.4 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904110231","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069082330","type":"NDC"}],"standard_charges":[{"gross_charge":10.14,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069082301","type":"NDC"}],"standard_charges":[{"gross_charge":10.14,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687085599","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687085592","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219161701","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888002406","type":"NDC"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543045110","type":"NDC"}],"standard_charges":[{"gross_charge":18.19,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543045101","type":"NDC"}],"standard_charges":[{"gross_charge":18.19,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238161703","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238161701","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543037901","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603155410","type":"NDC"}],"standard_charges":[{"gross_charge":6.64,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603155416","type":"NDC"}],"standard_charges":[{"gross_charge":6.63,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76439034330","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"povidone-iodine 10 % ointment 28.4 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536127180","type":"NDC"}],"standard_charges":[{"gross_charge":6.56,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 mEq packet 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76439034310","type":"NDC"}],"standard_charges":[{"gross_charge":3.41,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"povidone-iodine 10 % solution 14.8 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"67618015005","type":"NDC"}],"standard_charges":[{"gross_charge":5.66,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"povidone-iodine 10 % solution 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50425001198","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 5 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057233","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 5 MG capsule 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057232","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 5 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904702261","type":"NDC"}],"standard_charges":[{"gross_charge":15.19,"discounted_cash":3.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 2 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079063101","type":"NDC"}],"standard_charges":[{"gross_charge":10.11,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 2 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904702161","type":"NDC"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 2 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084099711","type":"NDC"}],"standard_charges":[{"gross_charge":8.64,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 2 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084099701","type":"NDC"}],"standard_charges":[{"gross_charge":8.64,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 1 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079063001","type":"NDC"}],"standard_charges":[{"gross_charge":7.54,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 1 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904702061","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 1 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954001910","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 1 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084099611","type":"NDC"}],"standard_charges":[{"gross_charge":5.78,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 1 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084099601","type":"NDC"}],"standard_charges":[{"gross_charge":5.78,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"povidone-iodine 10 % solution 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"53329093904","type":"NDC"}],"standard_charges":[{"gross_charge":34.2,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"povidone-iodine 10 % solution 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"52380480108","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"povidone-iodine 10 % solution 88 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"53329093988","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"povidone-iodine 10 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"395232516","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pilocarpine 4 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314020615","type":"NDC"}],"standard_charges":[{"gross_charge":204.69,"discounted_cash":51.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pilocarpine 2 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314020415","type":"NDC"}],"standard_charges":[{"gross_charge":201.73,"discounted_cash":50.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pilocarpine 2 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"998020415","type":"NDC"}],"standard_charges":[{"gross_charge":372.02,"discounted_cash":93.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.25 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50323000602","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.25 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24134803","type":"NDC"}],"standard_charges":[{"gross_charge":16.19,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 97.2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13517062801","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 97.2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571066801","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 97.2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75826014210","type":"NDC"}],"standard_charges":[{"gross_charge":3.91,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 97.2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603516821","type":"NDC"}],"standard_charges":[{"gross_charge":4.78,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 64.8 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571066701","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 64.8 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75826014110","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 64.8 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13517011201","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 64.8 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293062701","type":"NDC"}],"standard_charges":[{"gross_charge":4.67,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 64.8 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603516721","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 32.4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904657561","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 16.2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739019210","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 16.2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75826013710","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbitaL 16.2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603516521","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.25 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69536002515","type":"NDC"}],"standard_charges":[{"gross_charge":14.11,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.25 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"225080047","type":"NDC"}],"standard_charges":[{"gross_charge":18.46,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.5 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24135301","type":"NDC"}],"standard_charges":[{"gross_charge":16.19,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.5 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50323000603","type":"NDC"}],"standard_charges":[{"gross_charge":1693.44,"discounted_cash":423.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pilocarpine 1 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"gross_charge":268.57,"discounted_cash":67.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pilocarpine 1 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70069018101","type":"NDC"}],"standard_charges":[{"gross_charge":159.01,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687084111","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687084101","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664080888","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904618761","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862069201","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71036940","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 125 mg/5 mL suspension 237 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60432013108","type":"NDC"}],"standard_charges":[{"gross_charge":130.4,"discounted_cash":32.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 2.5 % drops 2 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"gross_charge":73.63,"discounted_cash":18.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 2.5 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42702010210","type":"NDC"}],"standard_charges":[{"gross_charge":234.86,"discounted_cash":58.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 2.5 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478020102","type":"NDC"}],"standard_charges":[{"gross_charge":166.49,"discounted_cash":41.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.5 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"225080547","type":"NDC"}],"standard_charges":[{"gross_charge":18.46,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.5 % spray,non-aerosol 21 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69536005021","type":"NDC"}],"standard_charges":[{"gross_charge":14.11,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.5 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69536005015","type":"NDC"}],"standard_charges":[{"gross_charge":14.11,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672411101","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50024043100","type":"NDC"}],"standard_charges":[{"gross_charge":21.23,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672128901","type":"NDC"}],"standard_charges":[{"gross_charge":34.08,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"603781874","type":"NDC"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817036210","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332011431","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904634261","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378004701","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584026701","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079080201","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93220301","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687063111","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687063101","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084067611","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084067601","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739029310","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079088801","type":"NDC"}],"standard_charges":[{"gross_charge":4.12,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084000911","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone per 4 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"59746000106","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584026601","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone per 4 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"904691461","type":"NDC"}],"standard_charges":[{"gross_charge":6.91,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584026611","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378003201","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055011","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055001","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268053515","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268053511","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687042411","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904656861","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292000101","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300022701","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904715661","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687052611","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687052601","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904145361","type":"NDC"}],"standard_charges":[{"gross_charge":3.42,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079080101","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904711861","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332011331","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862006301","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone per 4 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"68084014911","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone per 4 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"603459321","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone per 4 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"59762005001","type":"NDC"}],"standard_charges":[{"gross_charge":7.1,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084005601","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687021411","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687021401","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406575523","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406575562","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54855424","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904741761","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54071025","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904653061","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084073811","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406577123","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406577162","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 5 mg/5 mL solution 500 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54355563","type":"NDC"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094003162","type":"NDC"}],"standard_charges":[{"gross_charge":9.85,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094003159","type":"NDC"}],"standard_charges":[{"gross_charge":9.85,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084005611","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268053611","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547040510","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385012301","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729047801","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702010001","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 5 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084080521","type":"NDC"}],"standard_charges":[{"gross_charge":9.61,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084080511","type":"NDC"}],"standard_charges":[{"gross_charge":9.61,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406114201","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729047901","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702010101","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904712661","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 10 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084082321","type":"NDC"}],"standard_charges":[{"gross_charge":7.22,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406114401","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781574901","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739099110","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904705761","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055911","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055901","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methocarbamoL 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010075401","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084082311","type":"NDC"}],"standard_charges":[{"gross_charge":7.22,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"gross_charge":17.33,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111033401","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole 2 % cream 14 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"61269073514","type":"NDC"}],"standard_charges":[{"gross_charge":4.94,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.4 MG tablet, sublingual 25 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598043635","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine 10 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904722961","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192061501","type":"NDC"}],"standard_charges":[{"gross_charge":3.86,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687042511","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine 10 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687042501","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084002211","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155019401","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762100401","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEdipine 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386044024","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin-gramicidin 1.75 mg-10,000 unit-0.025mg/mL drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208079062","type":"NDC"}],"standard_charges":[{"gross_charge":192.32,"discounted_cash":48.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049111","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049101","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739040310","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268059611","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462019001","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.4 MG tablet, sublingual 25 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762330403","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 375 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268059511","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.4 MG tablet, sublingual 25 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71041813","type":"NDC"}],"standard_charges":[{"gross_charge":7.33,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672400101","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 25 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93081101","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 25 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687029311","type":"NDC"}],"standard_charges":[{"gross_charge":2.57,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 25 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687029301","type":"NDC"}],"standard_charges":[{"gross_charge":2.57,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 25 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268060415","type":"NDC"}],"standard_charges":[{"gross_charge":3.09,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 25 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268060411","type":"NDC"}],"standard_charges":[{"gross_charge":3.09,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 25 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672400201","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 25 MG capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672400205","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93081001","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687090011","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 10 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687090001","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907006901","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687028111","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 10 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268060315","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268060311","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nortriptyline 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862001501","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 2 % ointment 1 g Packet","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"281032608","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 375 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462018901","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010013701","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162018810","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minoxidiL 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489038701","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minoxidiL 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084020511","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minocycline 100 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904688806","type":"NDC"}],"standard_charges":[{"gross_charge":4.81,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minocycline 100 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687033665","type":"NDC"}],"standard_charges":[{"gross_charge":5.2,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minocycline 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687033611","type":"NDC"}],"standard_charges":[{"gross_charge":5.2,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minocycline 100 MG capsule 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382031818","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil enema 133 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"1320030140","type":"NDC"}],"standard_charges":[{"gross_charge":8.94,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil enema 133 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"132030140","type":"NDC"}],"standard_charges":[{"gross_charge":10.61,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil oil 473 mL Bottle","drug_information":{"unit":0.03171,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000044801","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil oil 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"48433020230","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole 2 % cream 45 g TUBE/KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672203506","type":"NDC"}],"standard_charges":[{"gross_charge":18.14,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole 2 % cream 45 g TUBE/KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904773445","type":"NDC"}],"standard_charges":[{"gross_charge":23.06,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole 2 % cream 45 g TUBE/KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472073063","type":"NDC"}],"standard_charges":[{"gross_charge":26.46,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole 2 % cream 45 g TUBE/KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472073041","type":"NDC"}],"standard_charges":[{"gross_charge":24.95,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole 2 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672200101","type":"NDC"}],"standard_charges":[{"gross_charge":12.16,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minoxidiL 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084020411","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 10 mg/5 mL solution 500 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54023763","type":"NDC"}],"standard_charges":[{"gross_charge":96.6,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689003250","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 10 mg/5 mL solution 0.5 mL Syringe","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710205100","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268059415","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268059411","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naproxen 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462018801","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nadoloL 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079081301","type":"NDC"}],"standard_charges":[{"gross_charge":31.35,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nadoloL 40 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904707161","type":"NDC"}],"standard_charges":[{"gross_charge":15.31,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nadoloL 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385013401","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nadoloL 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097086807","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole 2 % cream 14 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472073514","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 30 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54023625","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406511823","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406511862","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54023524","type":"NDC"}],"standard_charges":[{"gross_charge":4.01,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687076040","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121090405","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094000159","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 10 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710209105","type":"NDC"}],"standard_charges":[{"gross_charge":0.82,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 30 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54023624","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 20 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862029590","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 30 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000000101","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 30 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"41100081125","type":"NDC"}],"standard_charges":[{"gross_charge":49.27,"discounted_cash":12.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % cream 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472034356","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % cream 28.4 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472032126","type":"NDC"}],"standard_charges":[{"gross_charge":20.99,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % cream 28.4 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672206902","type":"NDC"}],"standard_charges":[{"gross_charge":13.84,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 0.5 % cream 28.4 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672201002","type":"NDC"}],"standard_charges":[{"gross_charge":20.16,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 0.5 % cream 28.35 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168001431","type":"NDC"}],"standard_charges":[{"gross_charge":11.19,"discounted_cash":2.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroCHLOROthiazide 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584036210","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroCHLOROthiazide 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155000901","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroCHLOROthiazide 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729018401","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroCHLOROthiazide 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584036110","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroCHLOROthiazide 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059311","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroCHLOROthiazide 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059301","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroCHLOROthiazide 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155000801","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroCHLOROthiazide 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729018301","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroCHLOROthiazide 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739012810","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"memantine 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650561","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % cream 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"61269034356","type":"NDC"}],"standard_charges":[{"gross_charge":7.06,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"memantine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591387045","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % cream 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"gross_charge":8.82,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % cream 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168008031","type":"NDC"}],"standard_charges":[{"gross_charge":15.37,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687051101","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115169701","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42543014101","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54505033210","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762007401","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084046911","type":"NDC"}],"standard_charges":[{"gross_charge":3.87,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % ointment 20 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802001402","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % ointment 28.35 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168014630","type":"NDC"}],"standard_charges":[{"gross_charge":14.29,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % ointment 28.4 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672201802","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % ointment 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802027603","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % ointment 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472034556","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % lotion 59 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"45802093716","type":"NDC"}],"standard_charges":[{"gross_charge":31.47,"discounted_cash":7.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % lotion 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63736033942","type":"NDC"}],"standard_charges":[{"gross_charge":31.72,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 1 % lotion 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"394085932","type":"NDC"}],"standard_charges":[{"gross_charge":40.14,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % cream 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472033730","type":"NDC"}],"standard_charges":[{"gross_charge":7.94,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2.5 % cream 28.35 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672300302","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687051111","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"memantine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456320511","type":"NDC"}],"standard_charges":[{"gross_charge":29.97,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904744961","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155083201","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904644061","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084044711","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 10 MG tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155000110","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155000101","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079007401","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenoL 1.4 % aerosol,spray 177 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000045801","type":"NDC"}],"standard_charges":[{"gross_charge":7.43,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenoL 1.4 % aerosol,spray 177 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536122858","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenoL 1.4 % aerosol,spray 177 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"87701042581","type":"NDC"}],"standard_charges":[{"gross_charge":14.87,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenoL 1.4 % aerosol,spray 177 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904630521","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenoL 1.4 % aerosol,spray 20 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"78112069480","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenoL 1.4 % aerosol,spray 177 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"78112001104","type":"NDC"}],"standard_charges":[{"gross_charge":23.79,"discounted_cash":5.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"memantine 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650606","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"memantine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650661","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"memantine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591387545","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904744761","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111032801","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eplerenone 25 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762171002","type":"NDC"}],"standard_charges":[{"gross_charge":9.97,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584073311","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155083401","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739032810","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904644261","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739012710","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584073411","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079007601","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155000301","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904744861","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687082211","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687082201","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155083301","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739032710","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904644161","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739012610","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722052001","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079007501","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380097106","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687058201","type":"NDC"}],"standard_charges":[{"gross_charge":7.79,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687058211","type":"NDC"}],"standard_charges":[{"gross_charge":7.79,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60432015004","type":"NDC"}],"standard_charges":[{"gross_charge":41.63,"discounted_cash":10.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69452039588","type":"NDC"}],"standard_charges":[{"gross_charge":266.2,"discounted_cash":66.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220505","type":"NDC"}],"standard_charges":[{"gross_charge":26.63,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62135075047","type":"NDC"}],"standard_charges":[{"gross_charge":2519.01,"discounted_cash":629.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710219905","type":"NDC"}],"standard_charges":[{"gross_charge":26.63,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62135050247","type":"NDC"}],"standard_charges":[{"gross_charge":2519.01,"discounted_cash":629.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710215905","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710208805","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710207505","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":0.04237,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710204205","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 5 mL Cup","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710204105","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54838050280","type":"NDC"}],"standard_charges":[{"gross_charge":268.19,"discounted_cash":67.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 25 MG tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237010099","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904634061","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584026511","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 10 mg/5 mL solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60432015016","type":"NDC"}],"standard_charges":[{"gross_charge":49.67,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584026501","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084025411","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739048610","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg/15 mL solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689002301","type":"NDC"}],"standard_charges":[{"gross_charge":17.77,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyoscyamine 0.125 mg/5 mL elixir 473 mL Bottle","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54838051180","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyoscyamine 0.125 mg/5 mL elixir 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220705","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyoscyamine 0.125 mg/5 mL elixir 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710218505","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyoscyamine 0.125 mg/5 mL elixir 473 mL Bottle","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62135051147","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyoscyamine 0.125 mg/5 mL elixir 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856051405","type":"NDC"}],"standard_charges":[{"gross_charge":5.71,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904661861","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155050201","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079081601","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084025511","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571011401","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687067511","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687067501","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904661761","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155050101","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrOXYzine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079080601","type":"NDC"}],"standard_charges":[{"gross_charge":2.11,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079025501","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol tartrate 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378001801","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"escitalopram 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687086511","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 25 mg suppository 24 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571067642","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 25 mg suppository 12 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571067621","type":"NDC"}],"standard_charges":[{"gross_charge":6.96,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 25 mg suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59741030112","type":"NDC"}],"standard_charges":[{"gross_charge":13.57,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 25 mg suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"713050306","type":"NDC"}],"standard_charges":[{"gross_charge":69.59,"discounted_cash":17.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 25 mg suppository 24 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"713050324","type":"NDC"}],"standard_charges":[{"gross_charge":37.03,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 25 mg suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574709012","type":"NDC"}],"standard_charges":[{"gross_charge":45.08,"discounted_cash":11.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Saccharomyces boulardii 250 mg capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904723006","type":"NDC"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Saccharomyces boulardii 250 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856086905","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Saccharomyces boulardii 250 mg capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333080050","type":"NDC"}],"standard_charges":[{"gross_charge":4.07,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Saccharomyces boulardii 250 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333080025","type":"NDC"}],"standard_charges":[{"gross_charge":4.07,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Saccharomyces boulardii 250 mg capsule 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896086905","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Saccharomyces boulardii 250 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856000201","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Saccharomyces boulardii 250 mg capsule 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4142000007","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Saccharomyces boulardii 250 mg capsule 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66825000201","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904718861","type":"NDC"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrogen peroxide 3 % solution 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"10565000104","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011045201","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406324301","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858030101","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"escitalopram 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547028010","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"escitalopram 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180013701","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"escitalopram 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862037301","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084034301","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 50 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382013914","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084034311","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079072701","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"memantine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591387544","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 4 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059011","type":"NDC"}],"standard_charges":[{"gross_charge":2.7,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858030225","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 4 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858030201","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 4 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406324401","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54026424","type":"NDC"}],"standard_charges":[{"gross_charge":2.45,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057901","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057911","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858030125","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059001","type":"NDC"}],"standard_charges":[{"gross_charge":2.7,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"memantine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456321011","type":"NDC"}],"standard_charges":[{"gross_charge":29.97,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383077116","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"81033002250","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079073620","type":"NDC"}],"standard_charges":[{"gross_charge":3.61,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904750461","type":"NDC"}],"standard_charges":[{"gross_charge":3.16,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904739161","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904724261","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781139313","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904592461","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378021401","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079073501","type":"NDC"}],"standard_charges":[{"gross_charge":3.95,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832155089","type":"NDC"}],"standard_charges":[{"gross_charge":4.45,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832155001","type":"NDC"}],"standard_charges":[{"gross_charge":4.45,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904673361","type":"NDC"}],"standard_charges":[{"gross_charge":4.13,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781139713","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079043101","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084024911","type":"NDC"}],"standard_charges":[{"gross_charge":4.88,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382008001","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079073601","type":"NDC"}],"standard_charges":[{"gross_charge":3.61,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756000211","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904592561","type":"NDC"}],"standard_charges":[{"gross_charge":3.46,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382007901","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ tablet,ER particles/crystals 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739044610","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol 2 mg/mL concentrate 120 mL Bottle","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93960412","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol 2 mg/mL concentrate 120 mL Bottle","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54838050140","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol 2 mg/mL concentrate 5 mL Cup","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904711270","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol 2 mg/mL concentrate 5 mL Cup","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904711241","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol 2 mg/mL concentrate 5 mL Syringe","drug_information":{"unit":0.04167,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710209705","type":"NDC"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol 2 mg/mL concentrate 5 mL Syringe","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710203505","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol 2 mg/mL concentrate 5 mL Syringe","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710203405","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol 2 mg/mL concentrate 5 mL Cup","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121058105","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol 2 mg/mL concentrate 120 mL Bottle","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121058104","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657090310","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657090301","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832154089","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904678261","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687016111","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781139613","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904739061","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832152089","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781139213","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888001201","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817033010","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547039910","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084075395","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084075325","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268019015","type":"NDC"}],"standard_charges":[{"gross_charge":2.91,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268019011","type":"NDC"}],"standard_charges":[{"gross_charge":2.91,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702000601","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 40 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268071115","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268071111","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 40 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904678161","type":"NDC"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 40 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205000590","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 40 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462026430","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 20 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268071015","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268071011","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93342001","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904740004","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclobenzaprine 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904740006","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE 0.05 % dropperette 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23916330","type":"NDC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":10.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904592361","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079073401","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781139113","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079073301","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidoL 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079073320","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"moxifloxacin 0.5 % drops 3 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"832141003","type":"NDC"}],"standard_charges":[{"gross_charge":151.33,"discounted_cash":37.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"moxifloxacin 0.5 % drops 3 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"72266015801","type":"NDC"}],"standard_charges":[{"gross_charge":37.96,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ tablet,ER particles/crystals 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084063201","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"moxifloxacin 0.5 % drops 3 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862084003","type":"NDC"}],"standard_charges":[{"gross_charge":130.75,"discounted_cash":32.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"moxifloxacin 0.5 % drops 3 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60505058204","type":"NDC"}],"standard_charges":[{"gross_charge":414.41,"discounted_cash":103.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"moxifloxacin 0.5 % drops 3 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"781713593","type":"NDC"}],"standard_charges":[{"gross_charge":136.71,"discounted_cash":34.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 100 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121148810","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 100 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121148800","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 100 mg/5 mL liquid 10 mL Syringe","drug_information":{"unit":0.02114,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710208106","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 100 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121174410","type":"NDC"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 100 mg/5 mL liquid 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121174405","type":"NDC"}],"standard_charges":[{"gross_charge":7.39,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"moxifloxacin 0.5 % drops 3 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68180042201","type":"NDC"}],"standard_charges":[{"gross_charge":47.63,"discounted_cash":11.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg/15 mL solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121477215","type":"NDC"}],"standard_charges":[{"gross_charge":9.14,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ tablet,ER particles/crystals 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084063211","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ tablet,ER particles/crystals 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245531789","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 300 MG tablet extended release 24 hr 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084025211","type":"NDC"}],"standard_charges":[{"gross_charge":5.62,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904750504","type":"NDC"}],"standard_charges":[{"gross_charge":5.51,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708461","type":"NDC"}],"standard_charges":[{"gross_charge":6.57,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708404","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436001004","type":"NDC"}],"standard_charges":[{"gross_charge":4.91,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729044315","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979010106","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781552831","type":"NDC"}],"standard_charges":[{"gross_charge":3.19,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598065530","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180031909","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180031906","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687031211","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687031201","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097087502","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079004701","type":"NDC"}],"standard_charges":[{"gross_charge":12.69,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 300 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079010901","type":"NDC"}],"standard_charges":[{"gross_charge":7.74,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115681108","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 300 MG tablet extended release 24 hr 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904657304","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 300 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979010206","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"81033002210","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"48433022040","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"48433022010","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904727966","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121187010","type":"NDC"}],"standard_charges":[{"gross_charge":8.53,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856077102","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217706","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383034911","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383034910","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383077110","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate 50 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121054410","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 0.125 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"56184012105","type":"NDC"}],"standard_charges":[{"gross_charge":17.01,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 300 MG tablet extended release 24 hr 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904746904","type":"NDC"}],"standard_charges":[{"gross_charge":6.64,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 300 MG tablet extended release 24 hr 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687079321","type":"NDC"}],"standard_charges":[{"gross_charge":7.26,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 300 MG tablet extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687079311","type":"NDC"}],"standard_charges":[{"gross_charge":7.26,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 300 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180032006","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion XL 150 MG tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370010103","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904677861","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 5 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862029390","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687075611","type":"NDC"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 80 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687075609","type":"NDC"}],"standard_charges":[{"gross_charge":2.9,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304098701","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904729361","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708661","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739097310","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832532511","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245531989","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758019006","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084036011","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739044710","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 20 MEQ tablet,ER particles/crystals 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781572001","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ tablet,ER particles/crystals 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904729261","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ tablet,ER particles/crystals 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708561","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ tablet,ER particles/crystals 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832532411","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amantadine 100 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084061111","type":"NDC"}],"standard_charges":[{"gross_charge":8.53,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amantadine 100 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904663061","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amantadine 100 mg capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704206","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amantadine 100 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704261","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rosuvastatin 5 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462026190","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin-dexAMETHasone 0.3-0.1 % drops,suspension 7.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65853302","type":"NDC"}],"standard_charges":[{"gross_charge":970.96,"discounted_cash":242.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin-dexAMETHasone 0.3-0.1 % drops,suspension 7.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62756042790","type":"NDC"}],"standard_charges":[{"gross_charge":325.8,"discounted_cash":81.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin-dexAMETHasone 0.3-0.1 % drops,suspension 7.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"43598032675","type":"NDC"}],"standard_charges":[{"gross_charge":560.04,"discounted_cash":140.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amantadine 100 mg/10 mL solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383080716","type":"NDC"}],"standard_charges":[{"gross_charge":21.85,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amantadine 100 mg/10 mL solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121064616","type":"NDC"}],"standard_charges":[{"gross_charge":79.46,"discounted_cash":19.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amantadine 100 mg/10 mL solution 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121064610","type":"NDC"}],"standard_charges":[{"gross_charge":17.98,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ tablet,ER particles/crystals 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66758017006","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148000735","type":"NDC"}],"standard_charges":[{"gross_charge":118.69,"discounted_cash":29.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598096630","type":"NDC"}],"standard_charges":[{"gross_charge":3.73,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598055530","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433011601","type":"NDC"}],"standard_charges":[{"gross_charge":14.21,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162089703","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862066230","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904651061","type":"NDC"}],"standard_charges":[{"gross_charge":21.52,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505267303","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904736706","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg/15 mL solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094071459","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg/15 mL solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094071462","type":"NDC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg/15 mL solution 15 mL Syringe","drug_information":{"unit":0.03171,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710203707","type":"NDC"}],"standard_charges":[{"gross_charge":4.54,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 mg/4 mL suspension 4 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687027562","type":"NDC"}],"standard_charges":[{"gross_charge":23.89,"discounted_cash":5.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 mg/4 mL suspension 4 mL Syringe","drug_information":{"unit":0.01688,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710205904","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 mg/4 mL suspension 4 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689003650","type":"NDC"}],"standard_charges":[{"gross_charge":25.49,"discounted_cash":6.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 mg/4 mL suspension 4 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689003601","type":"NDC"}],"standard_charges":[{"gross_charge":25.49,"discounted_cash":6.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin 500 unit/gram ointment in packet 144 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802006070","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin 500 unit/gram ointment in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802006000","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin 500 unit/gram ointment in packet 144 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904702367","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin 500 unit/gram ointment in packet 144 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67777021907","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin 500 unit/gram ointment in packet 144 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16784011613","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin 500 unit/gram ointment in packet 144 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904667967","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin 500 unit/gram ointment in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53329008987","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin 500 unit/gram ointment in packet 144 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53329008986","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin 500 unit/gram ointment in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54162001709","type":"NDC"}],"standard_charges":[{"gross_charge":0.3,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin regular per 5 Units","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"2821501","type":"NDC"}],"standard_charges":[{"gross_charge":59.47,"discounted_cash":14.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine suspension 16 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216108","type":"NDC"}],"standard_charges":[{"gross_charge":3.76,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 mg/4 mL suspension 4 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687027566","type":"NDC"}],"standard_charges":[{"gross_charge":23.89,"discounted_cash":5.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 mg/5 mL (8 mg/mL) suspension for reconstitution 5 mL Cup","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710222205","type":"NDC"}],"standard_charges":[{"gross_charge":9.67,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 mg/4 mL suspension 4 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121089250","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 mg/4 mL suspension 4 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904707924","type":"NDC"}],"standard_charges":[{"gross_charge":14.41,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121059515","type":"NDC"}],"standard_charges":[{"gross_charge":19.85,"discounted_cash":4.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904726594","type":"NDC"}],"standard_charges":[{"gross_charge":7.16,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904726541","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69339015717","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69339015705","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63739001971","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63739001970","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687024940","type":"NDC"}],"standard_charges":[{"gross_charge":13.04,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383024106","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383024105","type":"NDC"}],"standard_charges":[{"gross_charge":15.23,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121479905","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":2.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856024105","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689002850","type":"NDC"}],"standard_charges":[{"gross_charge":23.96,"discounted_cash":5.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689002801","type":"NDC"}],"standard_charges":[{"gross_charge":23.96,"discounted_cash":5.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 mg/4 mL suspension 4 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904707957","type":"NDC"}],"standard_charges":[{"gross_charge":14.41,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 100 mg/4 mL suspension 4 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121089263","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 mg/5 mL (8 mg/mL) suspension for reconstitution 5 mL Cup","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710222105","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 mg/5 mL (8 mg/mL) suspension for reconstitution 50 mL Bottle","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70954031610","type":"NDC"}],"standard_charges":[{"gross_charge":3.16,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 mg/5 mL (8 mg/mL) suspension for reconstitution 50 mL Bottle","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68180015001","type":"NDC"}],"standard_charges":[{"gross_charge":9.67,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904661961","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084008211","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781155613","type":"NDC"}],"standard_charges":[{"gross_charge":3.16,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781155601","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904634661","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143177101","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin (vitamin B-12) 500 mcg tablet,disintegrating 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74312003595","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eszopiclone 3 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342030111","type":"NDC"}],"standard_charges":[{"gross_charge":0.7,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eszopiclone 2 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80725001130","type":"NDC"}],"standard_charges":[{"gross_charge":142.91,"discounted_cash":35.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eszopiclone 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342030011","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eszopiclone 1 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862096730","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eszopiclone 1 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342029907","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eszopiclone 1 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93553756","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoniazid 300 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81665010810","type":"NDC"}],"standard_charges":[{"gross_charge":17.65,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoniazid 300 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64950021703","type":"NDC"}],"standard_charges":[{"gross_charge":18.93,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781169501","type":"NDC"}],"standard_charges":[{"gross_charge":3.82,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781169513","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084008311","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739036710","type":"NDC"}],"standard_charges":[{"gross_charge":3.67,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 220 mcg/actuation HFA aerosol inhaler 12 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"66993008096","type":"NDC"}],"standard_charges":[{"gross_charge":1143.93,"discounted_cash":285.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 220 mcg/actuation HFA aerosol inhaler 12 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"173072020","type":"NDC"}],"standard_charges":[{"gross_charge":1494.41,"discounted_cash":373.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 110 mcg/actuation HFA aerosol inhaler 12 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"66993007996","type":"NDC"}],"standard_charges":[{"gross_charge":802.47,"discounted_cash":200.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 110 mcg/actuation HFA aerosol inhaler 12 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"173071920","type":"NDC"}],"standard_charges":[{"gross_charge":962.14,"discounted_cash":240.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 44 mcg/actuation HFA aerosol inhaler 10.6 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"66993007896","type":"NDC"}],"standard_charges":[{"gross_charge":611.57,"discounted_cash":152.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 44 mcg/actuation HFA aerosol inhaler 10.6 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"173071820","type":"NDC"}],"standard_charges":[{"gross_charge":718.64,"discounted_cash":179.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884002001","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL BLIST PACK","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121059530","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268044715","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781163501","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143176901","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888008501","type":"NDC"}],"standard_charges":[{"gross_charge":22.84,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682019201","type":"NDC"}],"standard_charges":[{"gross_charge":84.78,"discounted_cash":21.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"187019201","type":"NDC"}],"standard_charges":[{"gross_charge":80.25,"discounted_cash":20.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888008301","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904662061","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosorbide dinitrate 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268044711","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoniazid 300 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055311","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL BLIST PACK","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710210909","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121059500","type":"NDC"}],"standard_charges":[{"gross_charge":19.85,"discounted_cash":4.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 5 mg/mL suspension 120 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710222401","type":"NDC"}],"standard_charges":[{"gross_charge":23.18,"discounted_cash":5.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethambutol 100 mg/ml suspension 60 mL Bottle","drug_information":{"unit":0.06667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710221001","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 10 mg/ml suspension 120 mL Bottle","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220801","type":"NDC"}],"standard_charges":[{"gross_charge":6.93,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone/hydroCHLOROthiazide 5 mg/5 mg/mL 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220901","type":"NDC"}],"standard_charges":[{"gross_charge":30.64,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE TOPICAL SOLUTION 1% 30 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710800809","type":"NDC"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin lispro per 50 Units","drug_information":{"unit":50.0,"type":"UN"},"code_information":[{"code":"637","type":"RC"},{"code":"J1817","type":"HCPCS"},{"code":"2751001","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose solution 473 mL Bottle","drug_information":{"unit":0.63425,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383079516","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose solution 473 mL Bottle","drug_information":{"unit":0.63425,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"45963043864","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":4.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose solution 473 mL Bottle","drug_information":{"unit":0.63425,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"603137858","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholestyramine 4 gram powder in packet 60 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877042260","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholestyramine 4 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877042257","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholestyramine 4 gram powder in packet 60 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382052860","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholestyramine 4 gram powder in packet 60 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382052960","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholestyramine 4 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884046564","type":"NDC"}],"standard_charges":[{"gross_charge":4.01,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholestyramine 4 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884046663","type":"NDC"}],"standard_charges":[{"gross_charge":11.94,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 0.5 mg tablet 0.5 each Package","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710100201","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholestyramine 4 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245003689","type":"NDC"}],"standard_charges":[{"gross_charge":8.18,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 0.5 mg tablet 0.5 each Package","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710100701","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 1.25 MG tablet 0.5 each Package","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710101001","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"41100081123","type":"NDC"}],"standard_charges":[{"gross_charge":32.57,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"37000080301","type":"NDC"}],"standard_charges":[{"gross_charge":23.18,"discounted_cash":5.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"23900001252","type":"NDC"}],"standard_charges":[{"gross_charge":19.91,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 30 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904571130","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216505","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216305","type":"NDC"}],"standard_charges":[{"gross_charge":3.95,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":0.01064,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710212305","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383031105","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":0.01064,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710208905","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 1.5 MG tablet 0.5 each Package","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710100901","type":"NDC"}],"standard_charges":[{"gross_charge":0.78,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 1.5 MG tablet 0.5 each Package","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710100401","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 1.25 MG tablet 0.5 each Package","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710100801","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholestyramine 4 gram powder in packet 60 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884046565","type":"NDC"}],"standard_charges":[{"gross_charge":4.01,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholestyramine 4 gram powder in packet 60 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"185094098","type":"NDC"}],"standard_charges":[{"gross_charge":7.17,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium citrate/glycerin sterile water 600 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710700206","type":"NDC"}],"standard_charges":[{"gross_charge":35.28,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710221905","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710221801","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710221605","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710221501","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217105","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217001","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 30 mL Bottle","drug_information":{"unit":0.00833,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"527192736","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 5 mL Syringe","drug_information":{"unit":0.00833,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216205","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.00833,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213101","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 1,000 mL Bottle","drug_information":{"unit":0.00025,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54039168","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 30 mL DROP BTL","drug_information":{"unit":0.00833,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689069430","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 473 mL Bottle","drug_information":{"unit":0.03171,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60258000116","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904731673","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904731662","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217809","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone 10 mg/mL concentrate 30 mL Bottle","drug_information":{"unit":0.00833,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54355344","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyrazinamide 10 mg/ml suspension 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710222901","type":"NDC"}],"standard_charges":[{"gross_charge":155.4,"discounted_cash":38.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 25mg/ml solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710212001","type":"NDC"}],"standard_charges":[{"gross_charge":113.4,"discounted_cash":28.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cherry syrup liquid 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"395266216","type":"NDC"}],"standard_charges":[{"gross_charge":119.56,"discounted_cash":29.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin 250 mg/5 mL syringe 5 mL Cup","drug_information":{"unit":0.00977,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710200105","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodiol 50 mg/ml suspension for reconstitution 100 mL Bottle","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710223001","type":"NDC"}],"standard_charges":[{"gross_charge":30.41,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 2 mg/mL tablet 50 mL Bottle","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710200301","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omeprazole 2 mg/mL suspension for reconstitution 50 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710200203","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydramine-nystatin suspension for reconstitution 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201006","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydramine-nystatin suspension for reconstitution 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201010","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucrose 24 % 2 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54758006155","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121119030","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"116400530","type":"NDC"}],"standard_charges":[{"gross_charge":5.54,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121115430","type":"NDC"}],"standard_charges":[{"gross_charge":7.18,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 30 mL Syringe","drug_information":{"unit":0.06342,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710208409","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 30 mL Syringe","drug_information":{"unit":0.06342,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710208509","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689003850","type":"NDC"}],"standard_charges":[{"gross_charge":4.28,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383077930","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"moxifloxacin 0.5 % drops 3 mL DROP BTL","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68180042201","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"116400511","type":"NDC"}],"standard_charges":[{"gross_charge":5.54,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxymetazoline 0.05 % spray,non-aerosol 30 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904676130","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoniazid 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055301","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoniazid 300 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555007102","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 600 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904585461","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 400 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687044611","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 400 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687044601","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 400 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877031901","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 400 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739067210","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 400 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084065811","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 400 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084065801","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 400 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904585360","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 400 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904585361","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904791461","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboxymethylcellulose sodium 1 % dropperette,gel 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58790000330","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboxymethylcellulose sodium 1 % dropperette,gel 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23455430","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687087776","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687087745","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"57237031631","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 600 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111068301","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"57237031603","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 600 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739068410","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 600 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877032001","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipramine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315013401","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipramine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781176413","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 mg/5 mL (4 mg/mL) solution 5 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687084540","type":"NDC"}],"standard_charges":[{"gross_charge":9.81,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 mg/5 mL (4 mg/mL) solution 5 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220305","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 mg/5 mL (4 mg/mL) solution 120 mL Bottle","drug_information":{"unit":0.02083,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70954060010","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 mg/5 mL (4 mg/mL) solution 5 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687024440","type":"NDC"}],"standard_charges":[{"gross_charge":7.73,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 mg/5 mL (4 mg/mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121472105","type":"NDC"}],"standard_charges":[{"gross_charge":21.57,"discounted_cash":5.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 mg/5 mL (4 mg/mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121072105","type":"NDC"}],"standard_charges":[{"gross_charge":17.26,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 mg/5 mL (4 mg/mL) solution 120 mL Bottle","drug_information":{"unit":0.02083,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121072104","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 800 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877032101","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 800 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739069110","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 800 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904585561","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 600 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687045711","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 600 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687045701","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 600 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877032005","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 600 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483060301","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904732573","type":"NDC"}],"standard_charges":[{"gross_charge":6.74,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904732562","type":"NDC"}],"standard_charges":[{"gross_charge":6.74,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710218409","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cinacalcet 60 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513007430","type":"NDC"}],"standard_charges":[{"gross_charge":136.84,"discounted_cash":34.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cinacalcet 30 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904706704","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":23.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cinacalcet 30 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380088304","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cinacalcet 30 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097041002","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cinacalcet 30 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436000704","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cinacalcet 30 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54868561600","type":"NDC"}],"standard_charges":[{"gross_charge":85.47,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cinacalcet 30 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513007330","type":"NDC"}],"standard_charges":[{"gross_charge":69.42,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxypropyl methylcellulose 2.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478006412","type":"NDC"}],"standard_charges":[{"gross_charge":105.65,"discounted_cash":26.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxypropyl methylcellulose 2.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17238061015","type":"NDC"}],"standard_charges":[{"gross_charge":28.92,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flavocoxid 250 mg capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68040060116","type":"NDC"}],"standard_charges":[{"gross_charge":51.87,"discounted_cash":12.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate 180 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378420178","type":"NDC"}],"standard_charges":[{"gross_charge":26.6,"discounted_cash":6.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg/15 mL solution 15 mL Cup","drug_information":{"unit":0.66667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220607","type":"NDC"}],"standard_charges":[{"gross_charge":21.13,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg/15 mL solution 473 mL Bottle","drug_information":{"unit":0.02114,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"64950037316","type":"NDC"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg/15 mL solution 15 mL Cup","drug_information":{"unit":0.66667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041744","type":"NDC"}],"standard_charges":[{"gross_charge":11.13,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone-acetaminophen 7.5-325 mg/15 mL solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121231615","type":"NDC"}],"standard_charges":[{"gross_charge":20.48,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranolol LA 60 MG capsule,extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991081701","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranolol LA 60 MG capsule,extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687021501","type":"NDC"}],"standard_charges":[{"gross_charge":9.01,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranolol LA 60 MG capsule,extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687021511","type":"NDC"}],"standard_charges":[{"gross_charge":9.01,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranolol LA 60 MG capsule,extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"527411637","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 355 mL Bottle","drug_information":{"unit":0.04225,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536129383","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689006001","type":"NDC"}],"standard_charges":[{"gross_charge":5.17,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904683873","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 355 mL Bottle","drug_information":{"unit":0.04225,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum-mag hydroxide-simeth 200-200-20 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121176130","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 473 mL Bottle","drug_information":{"unit":0.63425,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121057716","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipramine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584042610","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 946 mL Bottle","drug_information":{"unit":0.31712,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"64980059295","type":"NDC"}],"standard_charges":[{"gross_charge":20.16,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 473 mL Bottle","drug_information":{"unit":0.63425,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121087316","type":"NDC"}],"standard_charges":[{"gross_charge":34.02,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 473 mL Bottle","drug_information":{"unit":0.63425,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383077916","type":"NDC"}],"standard_charges":[{"gross_charge":21.42,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranolol LA 80 MG capsule,extended release 24 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687022611","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranolol LA 80 MG capsule,extended release 24 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687022601","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranolol LA 80 MG capsule,extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991081801","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactulose 10 gram/15 mL solution 946 mL Bottle","drug_information":{"unit":0.31712,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62135000394","type":"NDC"}],"standard_charges":[{"gross_charge":65.52,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoniazid 300 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687015811","type":"NDC"}],"standard_charges":[{"gross_charge":4.01,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipramine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380017001","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracin-polymyxin 3.5-400-10,000 mg-unit-unit/g ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574425035","type":"NDC"}],"standard_charges":[{"gross_charge":67.28,"discounted_cash":16.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687073401","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704461","type":"NDC"}],"standard_charges":[{"gross_charge":5.06,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904645361","type":"NDC"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505299603","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991074790","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180029509","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180029506","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084068311","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237001890","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237001830","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904636761","type":"NDC"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704361","type":"NDC"}],"standard_charges":[{"gross_charge":5.52,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704304","type":"NDC"}],"standard_charges":[{"gross_charge":5.2,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241009706","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292001920","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 30 MG capsule,delayed release(DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687073411","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292001901","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 60 MG capsule,delayed release(DR/EC) 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237001930","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 60 MG capsule,delayed release(DR/EC) 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180029606","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoniazid 300 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555007101","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoniazid 300 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079008301","type":"NDC"}],"standard_charges":[{"gross_charge":5.38,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 25 MCG tablet 0.25 each Package","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710100101","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate 2.5% gel 25 g","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"35181730332","type":"NDC"}],"standard_charges":[{"gross_charge":206.82,"discounted_cash":51.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate 2.5% gel 25 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"77683006306","type":"NDC"}],"standard_charges":[{"gross_charge":206.82,"discounted_cash":51.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydramine-alum hydroxide/mag hydroxide/simethicone-lidocaine viscous suspension for reconstitution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213307","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fenofibrate 145 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097045805","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fenofibrate 145 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079060820","type":"NDC"}],"standard_charges":[{"gross_charge":21.51,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fenofibrate 48 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802031575","type":"NDC"}],"standard_charges":[{"gross_charge":0.9,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 60 MG capsule,delayed release(DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687074511","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 60 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704561","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 60 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292002120","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 60 MG capsule,delayed release(DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292002101","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 60 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904645461","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 60 MG capsule,delayed release(DR/EC) 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180029609","type":"NDC"}],"standard_charges":[{"gross_charge":2.86,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 60 MG capsule,delayed release(DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084069211","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904645204","type":"NDC"}],"standard_charges":[{"gross_charge":4.53,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904645261","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991074690","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 50 mg suppository 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54195030","type":"NDC"}],"standard_charges":[{"gross_charge":638.65,"discounted_cash":159.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 50 mg suppository 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710185207","type":"NDC"}],"standard_charges":[{"gross_charge":861.32,"discounted_cash":215.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 50 mg suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710185206","type":"NDC"}],"standard_charges":[{"gross_charge":861.32,"discounted_cash":215.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 50 mg suppository 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69344010233","type":"NDC"}],"standard_charges":[{"gross_charge":861.32,"discounted_cash":215.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 50 mg suppository 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42211010243","type":"NDC"}],"standard_charges":[{"gross_charge":330.55,"discounted_cash":82.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 50 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079019101","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 50 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268043115","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 50 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268043111","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 50 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462030201","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 25 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079019001","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 25 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268043011","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 25 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462040601","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracin-polymyxin 3.5-400-10,000 mg-unit-unit/g ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24208078055","type":"NDC"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":17.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracin-polymyxin 3.5-400-10,000 mg-unit-unit/g ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"17478023535","type":"NDC"}],"standard_charges":[{"gross_charge":58.59,"discounted_cash":14.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracin-polymyxin 3.5-400-10,000 mg-unit-unit/g ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"16571075453","type":"NDC"}],"standard_charges":[{"gross_charge":69.43,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAXIMin 200 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649030103","type":"NDC"}],"standard_charges":[{"gross_charge":45.63,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 15 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"832046515","type":"NDC"}],"standard_charges":[{"gross_charge":24.13,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 30 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"832046530","type":"NDC"}],"standard_charges":[{"gross_charge":42.59,"discounted_cash":10.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 60 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"832046560","type":"NDC"}],"standard_charges":[{"gross_charge":75.35,"discounted_cash":18.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180029407","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084067511","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULoxetine 20 MG capsule,delayed release(DR/EC) 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237001760","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"emtricitabine-tenofovir (TDF) 200-300 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904717207","type":"NDC"}],"standard_charges":[{"gross_charge":12.61,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"emtricitabine-tenofovir (TDF) 200-300 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42385095330","type":"NDC"}],"standard_charges":[{"gross_charge":4.78,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"emtricitabine-tenofovir (TDF) 200-300 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93770456","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"emtricitabine-tenofovir (TDF) 200-300 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958070101","type":"NDC"}],"standard_charges":[{"gross_charge":458.63,"discounted_cash":114.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipramine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884005501","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 15 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"75907006044","type":"NDC"}],"standard_charges":[{"gross_charge":27.34,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 30 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"69315030630","type":"NDC"}],"standard_charges":[{"gross_charge":48.26,"discounted_cash":12.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 15 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"69315030615","type":"NDC"}],"standard_charges":[{"gross_charge":99.35,"discounted_cash":24.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 30 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574200830","type":"NDC"}],"standard_charges":[{"gross_charge":151.58,"discounted_cash":37.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 15 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574200815","type":"NDC"}],"standard_charges":[{"gross_charge":75.79,"discounted_cash":18.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 60 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574200802","type":"NDC"}],"standard_charges":[{"gross_charge":270.65,"discounted_cash":67.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 60 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"68308015260","type":"NDC"}],"standard_charges":[{"gross_charge":92.48,"discounted_cash":23.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 15 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"68308015215","type":"NDC"}],"standard_charges":[{"gross_charge":27.34,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nystatin 100,000 unit/gram powder 30 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"68382037002","type":"NDC"}],"standard_charges":[{"gross_charge":89.21,"discounted_cash":22.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60505100301","type":"NDC"}],"standard_charges":[{"gross_charge":198.49,"discounted_cash":49.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478020910","type":"NDC"}],"standard_charges":[{"gross_charge":193.79,"discounted_cash":48.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbachoL 0.01 % solution 1.5 mL Vial","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65002315","type":"NDC"}],"standard_charges":[{"gross_charge":38.79,"discounted_cash":9.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 10 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505014202","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505014200","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079081101","type":"NDC"}],"standard_charges":[{"gross_charge":2.91,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687070111","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687070101","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268036215","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268036211","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 325 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580047511","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 325 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580045811","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 325 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904677361","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 325 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580060002","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 325 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904198261","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ritonavir 100 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862068730","type":"NDC"}],"standard_charges":[{"gross_charge":11.41,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ritonavir 100 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54040713","type":"NDC"}],"standard_charges":[{"gross_charge":12.28,"discounted_cash":3.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ritonavir 100 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74333330","type":"NDC"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":16.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904663761","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluvoxaMINE 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559015901","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079081001","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glyBURIDE 2.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155005701","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904198861","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904198860","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37864000103","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536323101","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904581660","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 24 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580048824","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580048810","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guanFACINE 1 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904714004","type":"NDC"}],"standard_charges":[{"gross_charge":7.34,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guanFACINE 1 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687071021","type":"NDC"}],"standard_charges":[{"gross_charge":11.77,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guanFACINE 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687071011","type":"NDC"}],"standard_charges":[{"gross_charge":11.77,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guanFACINE 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979019801","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycopyrrolate 1 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904670961","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glyBURIDE 2.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93943301","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glyBURIDE 2.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93834301","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glyBURIDE 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079087201","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glipiZIDE 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505014100","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580041202","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904734661","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904578561","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462010230","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flecainide 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746064101","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flecainide 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54001020","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flecainide 50 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268032015","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flecainide 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268032011","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flecainide 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162064110","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flecainide 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746064201","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flecainide 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54001120","type":"NDC"}],"standard_charges":[{"gross_charge":4.53,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flecainide 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268032111","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flecainide 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162064210","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687042865","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687042811","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904683061","type":"NDC"}],"standard_charges":[{"gross_charge":3.34,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904683006","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268031415","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111014430","type":"NDC"}],"standard_charges":[{"gross_charge":8.03,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 20 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862019301","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084072801","type":"NDC"}],"standard_charges":[{"gross_charge":6.73,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650061","type":"NDC"}],"standard_charges":[{"gross_charge":6.21,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 10 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904734561","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862019201","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUoxetine 10 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904578461","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein-benoxinate 0.25-0.4 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"59390020605","type":"NDC"}],"standard_charges":[{"gross_charge":38.64,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein-benoxinate 0.25-0.4 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"59390021805","type":"NDC"}],"standard_charges":[{"gross_charge":87.44,"discounted_cash":21.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fludrocortisone 0.1 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904731706","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fludrocortisone 0.1 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268033011","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fludrocortisone 0.1 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084028811","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fludrocortisone 0.1 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115703301","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 50 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462010130","type":"NDC"}],"standard_charges":[{"gross_charge":3.34,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 200 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650106","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650161","type":"NDC"}],"standard_charges":[{"gross_charge":7.09,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 200 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084073511","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 200 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462010430","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"172541360","type":"NDC"}],"standard_charges":[{"gross_charge":6.61,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084072811","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710100601","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904673059","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536117201","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 120 MG suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802073200","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin NPH-insulin regular, human per 5 Units","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"2871501","type":"NDC"}],"standard_charges":[{"gross_charge":69.34,"discounted_cash":17.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin NPH-insulin regular, human per 5 Units","drug_information":{"unit":1000.0,"type":"UN"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"169183711","type":"NDC"}],"standard_charges":[{"gross_charge":58.8,"discounted_cash":14.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin NPH per 5 Units","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"2831501","type":"NDC"}],"standard_charges":[{"gross_charge":59.47,"discounted_cash":14.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin NPH per 5 Units","drug_information":{"unit":1000.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"169183411","type":"NDC"}],"standard_charges":[{"gross_charge":60.61,"discounted_cash":15.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 240 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904530909","type":"NDC"}],"standard_charges":[{"gross_charge":27.22,"discounted_cash":6.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687074340","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687074317","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710218905","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710218705","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094003701","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121091405","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 120 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"45018404","type":"NDC"}],"standard_charges":[{"gross_charge":50.4,"discounted_cash":12.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094060061","type":"NDC"}],"standard_charges":[{"gross_charge":3.89,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 120 MG suppository 6 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672211502","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094060062","type":"NDC"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 120 MG suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672211500","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketoconazole 2 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"93321915","type":"NDC"}],"standard_charges":[{"gross_charge":98.6,"discounted_cash":24.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079092901","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"185011701","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904745161","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904710961","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70377006012","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043911","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043901","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382079801","type":"NDC"}],"standard_charges":[{"gross_charge":2.03,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904592861","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079092801","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketoconazole 200 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672402606","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketoconazole 200 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672402601","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketoconazole 200 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"35573043330","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketoconazole 200 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"35573043302","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketoconazole 2 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672129801","type":"NDC"}],"standard_charges":[{"gross_charge":88.58,"discounted_cash":22.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketoconazole 2 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168009915","type":"NDC"}],"standard_charges":[{"gross_charge":32.82,"discounted_cash":8.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094060059","type":"NDC"}],"standard_charges":[{"gross_charge":3.89,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121183605","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 120 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904530920","type":"NDC"}],"standard_charges":[{"gross_charge":18.65,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 1 mg/mL liquid 4 mL Syringe","drug_information":{"unit":0.00423,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710203904","type":"NDC"}],"standard_charges":[{"gross_charge":5.87,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 1 mg/mL liquid 473 mL Bottle","drug_information":{"unit":0.00423,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42858030416","type":"NDC"}],"standard_charges":[{"gross_charge":4.89,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 1 mg/mL liquid 473 mL Bottle","drug_information":{"unit":0.00423,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54038663","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 100 mg/60 mL enema 60 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62559013811","type":"NDC"}],"standard_charges":[{"gross_charge":25.7,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone 100 mg/60 mL enema 60 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62559013807","type":"NDC"}],"standard_charges":[{"gross_charge":25.7,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580049010","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580045711","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536129229","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904674959","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904673060","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904672060","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"96295013234","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000031202","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000031201","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904673061","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 1 mg/mL liquid 4 mL Syringe","drug_information":{"unit":0.00423,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710204004","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 1 mg/mL liquid 4 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710221204","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 3 mg suppository 6 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574722406","type":"NDC"}],"standard_charges":[{"gross_charge":42.07,"discounted_cash":10.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine 200 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084026911","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 120 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50580018450","type":"NDC"}],"standard_charges":[{"gross_charge":32.26,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856530905","type":"NDC"}],"standard_charges":[{"gross_charge":5.78,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121477405","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibuprofen 100 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094049459","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxyurea 500 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884072401","type":"NDC"}],"standard_charges":[{"gross_charge":2.11,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxyurea 500 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315016401","type":"NDC"}],"standard_charges":[{"gross_charge":3.87,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxyurea 500 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904693961","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268031411","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxyurea 500 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084028411","type":"NDC"}],"standard_charges":[{"gross_charge":4.56,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine 200 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704606","type":"NDC"}],"standard_charges":[{"gross_charge":5.39,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine 200 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598072101","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine 200 mg tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781599405","type":"NDC"}],"standard_charges":[{"gross_charge":6.26,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine 200 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650806","type":"NDC"}],"standard_charges":[{"gross_charge":12.42,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine 200 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292001101","type":"NDC"}],"standard_charges":[{"gross_charge":7.01,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine 200 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904650861","type":"NDC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine 200 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739077710","type":"NDC"}],"standard_charges":[{"gross_charge":15.28,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxychloroquine 200 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704661","type":"NDC"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877028890","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268032311","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268032315","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754020301","type":"NDC"}],"standard_charges":[{"gross_charge":52.2,"discounted_cash":13.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409114405","type":"NDC"}],"standard_charges":[{"gross_charge":198.65,"discounted_cash":49.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409401101","type":"NDC"}],"standard_charges":[{"gross_charge":90.99,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tuberculin 5 tub. unit /0.1 mL solution 1 mL Vial","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"gross_charge":79.82,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tuberculin 5 tub. unit /0.1 mL solution 0.1 mL Syringe","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710507200","type":"NDC"}],"standard_charges":[{"gross_charge":62.21,"discounted_cash":15.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tuberculin 5 tub. unit /0.1 mL solution 1 mL Vial","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"49281075278","type":"NDC"}],"standard_charges":[{"gross_charge":79.82,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tuberculin 5 tub. unit /0.1 mL solution 5 mL Vial","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023010405","type":"NDC"}],"standard_charges":[{"gross_charge":62.19,"discounted_cash":15.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tuberculin 5 tub. unit /0.1 mL solution 1 mL Vial","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"gross_charge":79.82,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycerin 99.5 % solution 177 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"96295011389","type":"NDC"}],"standard_charges":[{"gross_charge":39.32,"discounted_cash":9.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycerin 99.5 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"395103116","type":"NDC"}],"standard_charges":[{"gross_charge":188.41,"discounted_cash":47.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycerin 99.5 % solution 177 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"395103196","type":"NDC"}],"standard_charges":[{"gross_charge":63.72,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trimethobenzamide 100 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023011801","type":"NDC"}],"standard_charges":[{"gross_charge":2381.19,"discounted_cash":595.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"selenium 40 mcg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"517651025","type":"NDC"}],"standard_charges":[{"gross_charge":128.99,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hypochlorite 0.125 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"39328006712","type":"NDC"}],"standard_charges":[{"gross_charge":144.93,"discounted_cash":36.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hypochlorite 0.125 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"39328006412","type":"NDC"}],"standard_charges":[{"gross_charge":112.32,"discounted_cash":28.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754020304","type":"NDC"}],"standard_charges":[{"gross_charge":49.88,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hypochlorite 0.125 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"436067216","type":"NDC"}],"standard_charges":[{"gross_charge":137.68,"discounted_cash":34.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754020401","type":"NDC"}],"standard_charges":[{"gross_charge":58.45,"discounted_cash":14.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70069027101","type":"NDC"}],"standard_charges":[{"gross_charge":21.02,"discounted_cash":5.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amobarbitaL 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42998030301","type":"NDC"}],"standard_charges":[{"gross_charge":5309.15,"discounted_cash":1327.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thrombin (recombinant) 5,000 unit recon soln 1 each KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"338032401","type":"NDC"}],"standard_charges":[{"gross_charge":311.76,"discounted_cash":77.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thrombin (recombinant) 5,000 unit recon soln 1 each KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"338032201","type":"NDC"}],"standard_charges":[{"gross_charge":311.76,"discounted_cash":77.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thrombin (recombinant) 5,000 unit recon soln 1 each KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43825060641","type":"NDC"}],"standard_charges":[{"gross_charge":368.83,"discounted_cash":92.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc sulfate 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"517611025","type":"NDC"}],"standard_charges":[{"gross_charge":127.16,"discounted_cash":31.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trypan blue 0.06 % syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"68803061210","type":"NDC"}],"standard_charges":[{"gross_charge":317.51,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150034225","type":"NDC"}],"standard_charges":[{"gross_charge":27.19,"discounted_cash":6.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150034201","type":"NDC"}],"standard_charges":[{"gross_charge":27.19,"discounted_cash":6.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"43066003125","type":"NDC"}],"standard_charges":[{"gross_charge":30.39,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"72485010825","type":"NDC"}],"standard_charges":[{"gross_charge":35.24,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"72485010801","type":"NDC"}],"standard_charges":[{"gross_charge":42.83,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409114465","type":"NDC"}],"standard_charges":[{"gross_charge":198.65,"discounted_cash":49.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121158505","type":"NDC"}],"standard_charges":[{"gross_charge":37.76,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121158501","type":"NDC"}],"standard_charges":[{"gross_charge":37.76,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70069027125","type":"NDC"}],"standard_charges":[{"gross_charge":20.88,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754020404","type":"NDC"}],"standard_charges":[{"gross_charge":58.45,"discounted_cash":14.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcholine 1 % (10 mg/mL) kit 1 each KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24208053920","type":"NDC"}],"standard_charges":[{"gross_charge":624.83,"discounted_cash":156.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"streptomycin 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822070602","type":"NDC"}],"standard_charges":[{"gross_charge":306.96,"discounted_cash":76.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323017015","type":"NDC"}],"standard_charges":[{"gross_charge":162.81,"discounted_cash":40.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"},{"gross_charge":89.27,"discounted_cash":22.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium acetate 2 mEq/mL solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409329905","type":"NDC"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":8.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium acetate 2 mEq/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409729973","type":"NDC"}],"standard_charges":[{"gross_charge":24.36,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methohexitaL 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023010501","type":"NDC"}],"standard_charges":[{"gross_charge":808.59,"discounted_cash":202.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chondroitin sulf-sod hyaluron 40-17 mg/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"8065183710","type":"NDC"}],"standard_charges":[{"gross_charge":470.17,"discounted_cash":117.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ringer's solution 1,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338010404","type":"NDC"}],"standard_charges":[{"gross_charge":28.26,"discounted_cash":7.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid 500 mg/mL solution 50 mL Vial","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457011850","type":"NDC"}],"standard_charges":[{"gross_charge":12.71,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323008605","type":"NDC"}],"standard_charges":[{"gross_charge":61.51,"discounted_cash":15.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70069074725","type":"NDC"}],"standard_charges":[{"gross_charge":109.16,"discounted_cash":27.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70069074701","type":"NDC"}],"standard_charges":[{"gross_charge":109.16,"discounted_cash":27.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"80830169102","type":"NDC"}],"standard_charges":[{"gross_charge":289.55,"discounted_cash":72.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"80830169101","type":"NDC"}],"standard_charges":[{"gross_charge":289.55,"discounted_cash":72.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219005429","type":"NDC"}],"standard_charges":[{"gross_charge":443.51,"discounted_cash":110.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219005409","type":"NDC"}],"standard_charges":[{"gross_charge":443.51,"discounted_cash":110.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219005229","type":"NDC"}],"standard_charges":[{"gross_charge":231.52,"discounted_cash":57.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219005209","type":"NDC"}],"standard_charges":[{"gross_charge":231.52,"discounted_cash":57.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium acetate 2 mEq/mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409329925","type":"NDC"}],"standard_charges":[{"gross_charge":49.02,"discounted_cash":12.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium acetate 2 mEq/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409729983","type":"NDC"}],"standard_charges":[{"gross_charge":24.36,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium acetate 2 mEq/mL solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409329915","type":"NDC"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":8.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409114112","type":"NDC"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323017005","type":"NDC"}],"standard_charges":[{"gross_charge":66.26,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"},{"gross_charge":36.33,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"517731525","type":"NDC"}],"standard_charges":[{"gross_charge":164.65,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"517731501","type":"NDC"}],"standard_charges":[{"gross_charge":164.65,"discounted_cash":41.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323088406","type":"NDC"}],"standard_charges":[{"gross_charge":297.21,"discounted_cash":74.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323088401","type":"NDC"}],"standard_charges":[{"gross_charge":297.21,"discounted_cash":74.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323088116","type":"NDC"}],"standard_charges":[{"gross_charge":631.15,"discounted_cash":157.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323088101","type":"NDC"}],"standard_charges":[{"gross_charge":631.15,"discounted_cash":157.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arginine (L-arginine) 10 % parenteral solution 300 mL Glass Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"9043601","type":"NDC"}],"standard_charges":[{"gross_charge":303.34,"discounted_cash":75.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409739182","type":"NDC"}],"standard_charges":[{"gross_charge":114.44,"discounted_cash":28.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"},{"gross_charge":62.75,"discounted_cash":15.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018730","type":"NDC"}],"standard_charges":[{"gross_charge":17.92,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323008861","type":"NDC"}],"standard_charges":[{"gross_charge":91.15,"discounted_cash":22.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 200 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323009903","type":"NDC"}],"standard_charges":[{"gross_charge":407.51,"discounted_cash":101.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323009561","type":"NDC"}],"standard_charges":[{"gross_charge":163.92,"discounted_cash":40.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323009502","type":"NDC"}],"standard_charges":[{"gross_charge":163.92,"discounted_cash":40.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323009330","type":"NDC"}],"standard_charges":[{"gross_charge":71.47,"discounted_cash":17.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 4 mEq/mL solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323009301","type":"NDC"}],"standard_charges":[{"gross_charge":71.47,"discounted_cash":17.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409739172","type":"NDC"}],"standard_charges":[{"gross_charge":114.44,"discounted_cash":28.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"},{"gross_charge":62.75,"discounted_cash":15.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904592961","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 0.1 % suspension 450 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"32909094503","type":"NDC"}],"standard_charges":[{"gross_charge":329.3,"discounted_cash":82.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409955805","type":"NDC"}],"standard_charges":[{"gross_charge":32.36,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079096601","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904578051","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111011901","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"172572880","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"172572860","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 mg/5 mL (8 mg/mL) suspension for reconstitution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70954031610","type":"NDC"}],"standard_charges":[{"gross_charge":126.21,"discounted_cash":31.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 mg/5 mL (8 mg/mL) suspension for reconstitution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68180015001","type":"NDC"}],"standard_charges":[{"gross_charge":386.61,"discounted_cash":96.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904729061","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904678961","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687037911","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687037901","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385010501","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084038911","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084038901","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 81 % (w/w) powder 148 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"250","type":"RC"},{"code":"32909010510","type":"NDC"}],"standard_charges":[{"gross_charge":503.2,"discounted_cash":125.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61442012101","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalaprilat 1.25 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143978701","type":"NDC"}],"standard_charges":[{"gross_charge":28.93,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268030311","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332000191","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729009015","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729009010","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"finasteride 5 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729009001","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268030415","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268030411","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61442012201","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"172572960","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16837085550","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904719306","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877084201","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904719361","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059511","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059501","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16837085516","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862085901","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739064510","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalaprilat 1.25 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143978710","type":"NDC"}],"standard_charges":[{"gross_charge":28.93,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalaprilat 1.25 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409212201","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 105 % (w/v), 58 % (w/w) suspension 1,900 mL Bottle","drug_information":{"unit":1.05263,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"32909016802","type":"NDC"}],"standard_charges":[{"gross_charge":762.86,"discounted_cash":190.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143925010","type":"NDC"}],"standard_charges":[{"gross_charge":39.33,"discounted_cash":9.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143925001","type":"NDC"}],"standard_charges":[{"gross_charge":39.33,"discounted_cash":9.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"43066001310","type":"NDC"}],"standard_charges":[{"gross_charge":27.19,"discounted_cash":6.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"43066000710","type":"NDC"}],"standard_charges":[{"gross_charge":12.91,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"47781061620","type":"NDC"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":6.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150022505","type":"NDC"}],"standard_charges":[{"gross_charge":13.98,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457057400","type":"NDC"}],"standard_charges":[{"gross_charge":31.1,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457057300","type":"NDC"}],"standard_charges":[{"gross_charge":16.81,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457022800","type":"NDC"}],"standard_charges":[{"gross_charge":34.13,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"39822420006","type":"NDC"}],"standard_charges":[{"gross_charge":39.91,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"39822420005","type":"NDC"}],"standard_charges":[{"gross_charge":39.91,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"39822420002","type":"NDC"}],"standard_charges":[{"gross_charge":25.39,"discounted_cash":6.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"39822420001","type":"NDC"}],"standard_charges":[{"gross_charge":25.39,"discounted_cash":6.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021066205","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323042605","type":"NDC"}],"standard_charges":[{"gross_charge":72.16,"discounted_cash":18.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409955811","type":"NDC"}],"standard_charges":[{"gross_charge":32.36,"discounted_cash":8.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323042602","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"43547053001","type":"NDC"}],"standard_charges":[{"gross_charge":18.96,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"43547053010","type":"NDC"}],"standard_charges":[{"gross_charge":18.96,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dantrolene 20 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"143929701","type":"NDC"}],"standard_charges":[{"gross_charge":609.89,"discounted_cash":152.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dantrolene 20 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023012306","type":"NDC"}],"standard_charges":[{"gross_charge":390.3,"discounted_cash":97.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 200 mg/20 mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"70710135906","type":"NDC"}],"standard_charges":[{"gross_charge":123.33,"discounted_cash":30.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 200 mg/20 mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"70710135901","type":"NDC"}],"standard_charges":[{"gross_charge":123.33,"discounted_cash":30.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 200 mg/20 mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"25021791020","type":"NDC"}],"standard_charges":[{"gross_charge":392.04,"discounted_cash":98.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 200 mg/20 mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"131181067","type":"NDC"}],"standard_charges":[{"gross_charge":718.35,"discounted_cash":179.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 60 % cream 454 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"250","type":"RC"},{"code":"32909077001","type":"NDC"}],"standard_charges":[{"gross_charge":1398.01,"discounted_cash":349.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 0.1 % suspension 450 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"32909092603","type":"NDC"}],"standard_charges":[{"gross_charge":51.71,"discounted_cash":12.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colistimethate 150 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0770","type":"HCPCS"},{"code":"39822061702","type":"NDC"}],"standard_charges":[{"gross_charge":87.47,"discounted_cash":21.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colistimethate 150 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0770","type":"HCPCS"},{"code":"63323039306","type":"NDC"}],"standard_charges":[{"gross_charge":79.59,"discounted_cash":19.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71839014110","type":"NDC"}],"standard_charges":[{"gross_charge":14.44,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71839014101","type":"NDC"}],"standard_charges":[{"gross_charge":14.44,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409318910","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409318905","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71288070006","type":"NDC"}],"standard_charges":[{"gross_charge":8.69,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71288070005","type":"NDC"}],"standard_charges":[{"gross_charge":8.69,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colistimethate 150 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0770","type":"HCPCS"},{"code":"42023010701","type":"NDC"}],"standard_charges":[{"gross_charge":76.14,"discounted_cash":19.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687012501","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687012511","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382079901","type":"NDC"}],"standard_charges":[{"gross_charge":2.46,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739014510","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904681806","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056215","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056211","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904681861","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687039811","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687039801","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056511","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739055610","type":"NDC"}],"standard_charges":[{"gross_charge":4.08,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056515","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245021289","type":"NDC"}],"standard_charges":[{"gross_charge":12.71,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505132101","type":"NDC"}],"standard_charges":[{"gross_charge":3.86,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079045301","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245021211","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 2.5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904681706","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756004911","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 2.5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056115","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg film 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12496120201","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg film 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598057901","type":"NDC"}],"standard_charges":[{"gross_charge":9.41,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25145160","type":"NDC"}],"standard_charges":[{"gross_charge":17.04,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25145134","type":"NDC"}],"standard_charges":[{"gross_charge":16.48,"discounted_cash":4.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084004011","type":"NDC"}],"standard_charges":[{"gross_charge":7.28,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386016012","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386016006","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin B-dexAMETHasone 3.5 mg/g-10,000 unit/g-0.1 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"61314063136","type":"NDC"}],"standard_charges":[{"gross_charge":70.31,"discounted_cash":17.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin B-dexAMETHasone 3.5 mg/g-10,000 unit/g-0.1 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"65063136","type":"NDC"}],"standard_charges":[{"gross_charge":759.7,"discounted_cash":189.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin B-dexAMETHasone 3.5 mg/g-10,000 unit/g-0.1 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"gross_charge":56.58,"discounted_cash":14.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin B-dexAMETHasone 3.5 mg/g-10,000 unit/g-0.1 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"78077101","type":"NDC"}],"standard_charges":[{"gross_charge":880.32,"discounted_cash":220.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin B-dexAMETHasone 3.5 mg/g-10,000 unit/g-0.1 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574416035","type":"NDC"}],"standard_charges":[{"gross_charge":31.66,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 8-2 mg film 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598058230","type":"NDC"}],"standard_charges":[{"gross_charge":15.68,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 8-2 mg film 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598058201","type":"NDC"}],"standard_charges":[{"gross_charge":15.68,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 8-2 mg film 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12496120803","type":"NDC"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 8-2 mg film 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12496120801","type":"NDC"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg film 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598057930","type":"NDC"}],"standard_charges":[{"gross_charge":9.41,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 2-0.5 mg film 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12496120203","type":"NDC"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":4.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056111","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056411","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 2.5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056415","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378617401","type":"NDC"}],"standard_charges":[{"gross_charge":8.79,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 12 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010078612","type":"NDC"}],"standard_charges":[{"gross_charge":55.78,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 28 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571073528","type":"NDC"}],"standard_charges":[{"gross_charge":60.14,"discounted_cash":15.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 12 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571073521","type":"NDC"}],"standard_charges":[{"gross_charge":63.99,"discounted_cash":16.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041094","type":"NDC"}],"standard_charges":[{"gross_charge":193.5,"discounted_cash":48.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041011","type":"NDC"}],"standard_charges":[{"gross_charge":193.5,"discounted_cash":48.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 28 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238160508","type":"NDC"}],"standard_charges":[{"gross_charge":111.7,"discounted_cash":27.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 12 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238160502","type":"NDC"}],"standard_charges":[{"gross_charge":65.45,"discounted_cash":16.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 12 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27437005057","type":"NDC"}],"standard_charges":[{"gross_charge":301.67,"discounted_cash":75.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 28 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27437005056","type":"NDC"}],"standard_charges":[{"gross_charge":301.49,"discounted_cash":75.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine 0.2 mg tablet 28 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386014028","type":"NDC"}],"standard_charges":[{"gross_charge":260.62,"discounted_cash":65.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687066911","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687066901","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687035711","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687035701","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"185560001","type":"NDC"}],"standard_charges":[{"gross_charge":4.26,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079002301","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904691661","type":"NDC"}],"standard_charges":[{"gross_charge":9.07,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 2.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888005201","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084024011","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 2.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505132001","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midodrine 2.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245021111","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"microfibrllar collagen 70 X 35 mm sheet 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53276101009","type":"NDC"}],"standard_charges":[{"gross_charge":2178.5,"discounted_cash":544.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 0.75 % (37.5mg/5 gram) gel 70 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"73473030370","type":"NDC"}],"standard_charges":[{"gross_charge":227.26,"discounted_cash":56.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 0.75 % (37.5mg/5 gram) gel 70 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802013970","type":"NDC"}],"standard_charges":[{"gross_charge":332.22,"discounted_cash":83.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 0.75 % (37.5mg/5 gram) gel 70 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"781707787","type":"NDC"}],"standard_charges":[{"gross_charge":641.8,"discounted_cash":160.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954044310","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 0.75 % (37.5mg/5 gram) gel 70 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"245086070","type":"NDC"}],"standard_charges":[{"gross_charge":485.98,"discounted_cash":121.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904713961","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904691561","type":"NDC"}],"standard_charges":[{"gross_charge":9.31,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079002401","type":"NDC"}],"standard_charges":[{"gross_charge":13.48,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 2.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"185505001","type":"NDC"}],"standard_charges":[{"gross_charge":3.34,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687062411","type":"NDC"}],"standard_charges":[{"gross_charge":11.72,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687062401","type":"NDC"}],"standard_charges":[{"gross_charge":11.72,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904713861","type":"NDC"}],"standard_charges":[{"gross_charge":9.71,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metOLazone 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904732961","type":"NDC"}],"standard_charges":[{"gross_charge":11.61,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155007001","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954044320","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687073511","type":"NDC"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 10 mL Syringe","drug_information":{"unit":0.04348,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710208706","type":"NDC"}],"standard_charges":[{"gross_charge":70.01,"discounted_cash":17.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 10 mL Syringe","drug_information":{"unit":0.04348,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710205410","type":"NDC"}],"standard_charges":[{"gross_charge":65.94,"discounted_cash":16.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 230 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65162068988","type":"NDC"}],"standard_charges":[{"gross_charge":2352.21,"discounted_cash":588.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 230 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"59630045008","type":"NDC"}],"standard_charges":[{"gross_charge":4600.09,"discounted_cash":1150.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niMODipine 30 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155051230","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niMODipine 30 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155051211","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niMODipine 30 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452020907","type":"NDC"}],"standard_charges":[{"gross_charge":7.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niMODipine 30 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559021052","type":"NDC"}],"standard_charges":[{"gross_charge":67.56,"discounted_cash":16.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niMODipine 30 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084091233","type":"NDC"}],"standard_charges":[{"gross_charge":7.94,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niMODipine 30 MG capsule 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084091232","type":"NDC"}],"standard_charges":[{"gross_charge":9.13,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine polacrilex 2 mg gum 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536136225","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine polacrilex 2 mg gum 110 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536302923","type":"NDC"}],"standard_charges":[{"gross_charge":0.8,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine polacrilex 2 mg gum 110 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904573411","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nicotine polacrilex 2 mg gum 110 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536136223","type":"NDC"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin-dexAMETHasone 3.5mg/mL-10,000 unit/mL-0.1 % drops,suspension 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314063006","type":"NDC"}],"standard_charges":[{"gross_charge":62.92,"discounted_cash":15.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710205606","type":"NDC"}],"standard_charges":[{"gross_charge":65.94,"discounted_cash":16.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin-dexAMETHasone 3.5mg/mL-10,000 unit/mL-0.1 % drops,suspension 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":55.78,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 240 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70408023932","type":"NDC"}],"standard_charges":[{"gross_charge":9775.58,"discounted_cash":2443.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 230 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70199000632","type":"NDC"}],"standard_charges":[{"gross_charge":10944.78,"discounted_cash":2736.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268062515","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268062511","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162047810","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52427028501","type":"NDC"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":6.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781030301","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084044611","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079034801","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"185012201","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220106","type":"NDC"}],"standard_charges":[{"gross_charge":378.08,"discounted_cash":94.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 230 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70954049610","type":"NDC"}],"standard_charges":[{"gross_charge":7780.16,"discounted_cash":1945.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710218005","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217906","type":"NDC"}],"standard_charges":[{"gross_charge":369.81,"discounted_cash":92.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 230 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"16571074024","type":"NDC"}],"standard_charges":[{"gross_charge":10971.83,"discounted_cash":2742.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710214706","type":"NDC"}],"standard_charges":[{"gross_charge":490.01,"discounted_cash":122.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710214306","type":"NDC"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin 25 mg/5 mL suspension 10 mL Syringe","drug_information":{"unit":0.04348,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710212106","type":"NDC"}],"standard_charges":[{"gross_charge":102.27,"discounted_cash":25.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naltrexone 50 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904703604","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naltrexone 50 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094085362","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naltrexone 50 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084029121","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dabigatran etexilate 150 mg capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"597036055","type":"NDC"}],"standard_charges":[{"gross_charge":12.49,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dabigatran etexilate 75 mg capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722062160","type":"NDC"}],"standard_charges":[{"gross_charge":8.88,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dabigatran etexilate 75 mg capsule 60 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"597035556","type":"NDC"}],"standard_charges":[{"gross_charge":13.49,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762500802","type":"NDC"}],"standard_charges":[{"gross_charge":4.77,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762500801","type":"NDC"}],"standard_charges":[{"gross_charge":4.77,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687074611","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687074601","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954044420","type":"NDC"}],"standard_charges":[{"gross_charge":3.95,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954044410","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25146134","type":"NDC"}],"standard_charges":[{"gross_charge":19.72,"discounted_cash":4.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084004111","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386016106","type":"NDC"}],"standard_charges":[{"gross_charge":3.95,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 200 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386016101","type":"NDC"}],"standard_charges":[{"gross_charge":3.92,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762500702","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762500701","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 30 mL Bottle","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"406800330","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 30 mL Bottle","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54040444","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 120 mL Bottle","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54040450","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 1 mL Syringe","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710205201","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naltrexone 50 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084029111","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naltrexone 50 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335032683","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 22 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":35.94,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 22 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"93101042","type":"NDC"}],"standard_charges":[{"gross_charge":35.57,"discounted_cash":8.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904728469","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904728454","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"81033002050","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miSOPROStol 100 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687073501","type":"NDC"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"81033002001","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 22 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":20.7,"discounted_cash":5.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 1 mL Syringe","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213401","type":"NDC"}],"standard_charges":[{"gross_charge":0.45,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 1 mL Syringe","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710211801","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 1 mL Syringe","drug_information":{"unit":0.06667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710211701","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 1 mL Syringe","drug_information":{"unit":0.00833,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710211301","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 120 mL Bottle","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54051750","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 100 mg/5 mL (20 mg/mL) solution 30 mL Bottle","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54051744","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 22 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"68462018022","type":"NDC"}],"standard_charges":[{"gross_charge":35.94,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409729511","type":"NDC"}],"standard_charges":[{"gross_charge":112.37,"discounted_cash":28.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687068011","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687037011","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-prilocaine 2.5-2.5 % cream 5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"62332058204","type":"NDC"}],"standard_charges":[{"gross_charge":42.34,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-prilocaine 2.5-2.5 % cream 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"63739005466","type":"NDC"}],"standard_charges":[{"gross_charge":34.9,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-prilocaine 2.5-2.5 % cream 5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"591207026","type":"NDC"}],"standard_charges":[{"gross_charge":37.19,"discounted_cash":9.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-prilocaine 2.5-2.5 % cream 5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168035705","type":"NDC"}],"standard_charges":[{"gross_charge":36.41,"discounted_cash":9.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-prilocaine 2.5-2.5 % cream 5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"115146853","type":"NDC"}],"standard_charges":[{"gross_charge":22.58,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-prilocaine 2.5-2.5 % cream 5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"115146860","type":"NDC"}],"standard_charges":[{"gross_charge":22.58,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-prilocaine 2.5-2.5 % cream 5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168035755","type":"NDC"}],"standard_charges":[{"gross_charge":36.41,"discounted_cash":9.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180097009","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"527328546","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904695461","type":"NDC"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050811","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050801","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180097001","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292003920","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292003901","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-prilocaine 2.5-2.5 % cream 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"50383066730","type":"NDC"}],"standard_charges":[{"gross_charge":119.57,"discounted_cash":29.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378181177","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832051200","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832051289","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180098001","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904648561","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739034910","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 5 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70377011412","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 5 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756058988","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 5 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794001812","type":"NDC"}],"standard_charges":[{"gross_charge":4.48,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 5 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862032001","type":"NDC"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 5 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794001802","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liothyronine 5 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60793011501","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687070011","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687070001","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904617861","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084070411","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268011411","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 25 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268011415","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832051201","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"527134601","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781518592","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 112 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74929690","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamsulosin 0.4 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079029401","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904745361","type":"NDC"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904711161","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 300 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70377006212","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 300 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687046111","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687046101","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 300 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382080001","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084045711","type":"NDC"}],"standard_charges":[{"gross_charge":3.86,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 300 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904593061","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 300 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"185011801","type":"NDC"}],"standard_charges":[{"gross_charge":3.27,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904745261","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904711061","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70377006112","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687045011","type":"NDC"}],"standard_charges":[{"gross_charge":3.41,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"labetalol 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687045001","type":"NDC"}],"standard_charges":[{"gross_charge":3.41,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamsulosin 0.4 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756016088","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamsulosin 0.4 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739056710","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamsulosin 0.4 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862059801","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamsulosin 0.4 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084029911","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 88 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180096809","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 88 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"527328346","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 88 MCG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904695261","type":"NDC"}],"standard_charges":[{"gross_charge":2.86,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 88 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687048611","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 88 MCG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292003801","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 88 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378180777","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 88 MCG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74659490","type":"NDC"}],"standard_charges":[{"gross_charge":7.59,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687032511","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 325 MG suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672211600","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 325 MG suppository 6 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672211602","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levobunoloL 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208050505","type":"NDC"}],"standard_charges":[{"gross_charge":15.88,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 8 mg tablet extended release 24 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406330801","type":"NDC"}],"standard_charges":[{"gross_charge":45.02,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamsulosin 0.4 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904738361","type":"NDC"}],"standard_charges":[{"gross_charge":2.11,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamsulosin 0.4 mg capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074015","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamsulosin 0.4 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074011","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamsulosin 0.4 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904640161","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 325 MG suppository 50 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672211604","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687068001","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679861","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084019601","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 4 gram/60 mL enema 60 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"45802009851","type":"NDC"}],"standard_charges":[{"gross_charge":41.33,"discounted_cash":10.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mercaptopurine 50 mg tablet 25 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378354752","type":"NDC"}],"standard_charges":[{"gross_charge":13.38,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mercaptopurine 50 mg tablet 25 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54458111","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melphalan 2 mg tablet 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52609000105","type":"NDC"}],"standard_charges":[{"gross_charge":44.13,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 650 MG suppository 50 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802073032","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 650 MG suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802073030","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 650 MG suppository 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802073000","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium oxide 400 mg (241.3 mg magnesium) tablet 300 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739005802","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium oxide 400 mg (241.3 mg magnesium) tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980033990","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium oxide 400 mg (241.3 mg magnesium) tablet 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980033912","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium oxide 400 mg (241.3 mg magnesium) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980033901","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium oxide 400 mg (241.3 mg magnesium) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10006070028","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium oxide 400 mg (241.3 mg magnesium) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739035410","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904751161","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802065075","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 4 gram/60 mL enema 60 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"45802009846","type":"NDC"}],"standard_charges":[{"gross_charge":45.36,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010016201","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 4 gram/60 mL enema 60 mL Packet","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"99710800260","type":"NDC"}],"standard_charges":[{"gross_charge":40.32,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 4 gram/60 mL enema 60 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62559042011","type":"NDC"}],"standard_charges":[{"gross_charge":69.8,"discounted_cash":17.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687037001","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methIMAzole 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155007101","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 50 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710223805","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 50 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710223705","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 50 mg/5 mL solution 200 mL Bottle","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68462094086","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 50 mg/5 mL solution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710218605","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 50 mg/5 mL solution 200 mL Bottle","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70954048810","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 50 mg/5 mL solution 200 mL Bottle","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"31722062726","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904716261","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 500 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010006305","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010006301","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904668961","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739064010","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079017201","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155010201","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 4 gram/60 mL enema 60 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62559042007","type":"NDC"}],"standard_charges":[{"gross_charge":69.8,"discounted_cash":17.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268048915","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268048911","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904685261","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propion-salmeteroL 250-50 mcg/dose blister with device 60 each BLIST PACK","drug_information":{"unit":0.01667,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54032756","type":"NDC"}],"standard_charges":[{"gross_charge":7.71,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propion-salmeteroL 250-50 mcg/dose blister with device 60 each BLIST PACK","drug_information":{"unit":0.01667,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378932132","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propion-salmeteroL 250-50 mcg/dose blister with device 14 each BLIST PACK","drug_information":{"unit":0.07143,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"173069604","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 450 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079014201","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 450 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084065511","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 450 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378145001","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 450 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54002025","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 300 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084064011","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 300 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079018001","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 300 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378130001","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lithium 300 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54002125","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687066711","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687066701","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679761","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084019611","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propion-salmeteroL 500-50 mcg/dose blister with device 14 each BLIST PACK","drug_information":{"unit":0.07143,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"173069704","type":"NDC"}],"standard_charges":[{"gross_charge":20.54,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propion-salmeteroL 500-50 mcg/dose blister with device 60 each BLIST PACK","drug_information":{"unit":0.01667,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378932232","type":"NDC"}],"standard_charges":[{"gross_charge":9.92,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propion-salmeteroL 500-50 mcg/dose blister with device 60 each BLIST PACK","drug_information":{"unit":0.01667,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54032856","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 650 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591372030","type":"NDC"}],"standard_charges":[{"gross_charge":22.92,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904579361","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079024601","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67067430","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802065078","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loratadine 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084024811","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAXIMin 550 mg tablet 60 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649030303","type":"NDC"}],"standard_charges":[{"gross_charge":230.46,"discounted_cash":57.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293064801","type":"NDC"}],"standard_charges":[{"gross_charge":5.38,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisinopriL 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180051301","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162057410","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832051300","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 650 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687075021","type":"NDC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 650 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687075011","type":"NDC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 650 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268077213","type":"NDC"}],"standard_charges":[{"gross_charge":18.81,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 650 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268077211","type":"NDC"}],"standard_charges":[{"gross_charge":18.81,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 650 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69918030130","type":"NDC"}],"standard_charges":[{"gross_charge":17.97,"discounted_cash":4.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 650 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505363803","type":"NDC"}],"standard_charges":[{"gross_charge":21.17,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bethanechol 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832051389","type":"NDC"}],"standard_charges":[{"gross_charge":5.97,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687063311","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium phosphate 3 mmol/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409729501","type":"NDC"}],"standard_charges":[{"gross_charge":112.37,"discounted_cash":28.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium iodide 1 gram/mL solution 30 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"75834028030","type":"NDC"}],"standard_charges":[{"gross_charge":2262.38,"discounted_cash":565.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023018710","type":"NDC"}],"standard_charges":[{"gross_charge":106.47,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023018701","type":"NDC"}],"standard_charges":[{"gross_charge":106.47,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"781349595","type":"NDC"}],"standard_charges":[{"gross_charge":157.03,"discounted_cash":39.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"781349546","type":"NDC"}],"standard_charges":[{"gross_charge":157.03,"discounted_cash":39.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"43598097511","type":"NDC"}],"standard_charges":[{"gross_charge":96.52,"discounted_cash":24.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121138907","type":"NDC"}],"standard_charges":[{"gross_charge":71.24,"discounted_cash":17.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121138901","type":"NDC"}],"standard_charges":[{"gross_charge":71.24,"discounted_cash":17.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409166035","type":"NDC"}],"standard_charges":[{"gross_charge":341.64,"discounted_cash":85.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338955712","type":"NDC"}],"standard_charges":[{"gross_charge":234.4,"discounted_cash":58.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409166010","type":"NDC"}],"standard_charges":[{"gross_charge":341.64,"discounted_cash":85.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 200 mcg/50 mL (4 mcg/mL) solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021061550","type":"NDC"}],"standard_charges":[{"gross_charge":45.19,"discounted_cash":11.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 200 mcg/50 mL (4 mcg/mL) solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121138808","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 200 mcg/50 mL (4 mcg/mL) solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121138801","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 200 mcg/50 mL (4 mcg/mL) solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409166055","type":"NDC"}],"standard_charges":[{"gross_charge":194.95,"discounted_cash":48.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 200 mcg/50 mL (4 mcg/mL) solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71225012605","type":"NDC"}],"standard_charges":[{"gross_charge":107.24,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457092500","type":"NDC"}],"standard_charges":[{"gross_charge":213.71,"discounted_cash":53.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 200 mcg/50 mL (4 mcg/mL) solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71225012602","type":"NDC"}],"standard_charges":[{"gross_charge":107.24,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457092510","type":"NDC"}],"standard_charges":[{"gross_charge":213.71,"discounted_cash":53.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143952510","type":"NDC"}],"standard_charges":[{"gross_charge":87.32,"discounted_cash":21.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 100 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143953201","type":"NDC"}],"standard_charges":[{"gross_charge":39.37,"discounted_cash":9.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 100 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323042116","type":"NDC"}],"standard_charges":[{"gross_charge":47.88,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 100 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323042102","type":"NDC"}],"standard_charges":[{"gross_charge":28.05,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 100 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457025100","type":"NDC"}],"standard_charges":[{"gross_charge":84.11,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 100 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409163802","type":"NDC"}],"standard_charges":[{"gross_charge":41.33,"discounted_cash":10.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409159610","type":"NDC"}],"standard_charges":[{"gross_charge":347.76,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409159601","type":"NDC"}],"standard_charges":[{"gross_charge":347.76,"discounted_cash":86.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121171203","type":"NDC"}],"standard_charges":[{"gross_charge":137.11,"discounted_cash":34.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121171201","type":"NDC"}],"standard_charges":[{"gross_charge":883.96,"discounted_cash":220.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"68094024710","type":"NDC"}],"standard_charges":[{"gross_charge":141.71,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"68094024701","type":"NDC"}],"standard_charges":[{"gross_charge":141.71,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71225013302","type":"NDC"}],"standard_charges":[{"gross_charge":178.48,"discounted_cash":44.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71225013301","type":"NDC"}],"standard_charges":[{"gross_charge":178.48,"discounted_cash":44.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150029710","type":"NDC"}],"standard_charges":[{"gross_charge":370.74,"discounted_cash":92.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150029701","type":"NDC"}],"standard_charges":[{"gross_charge":370.74,"discounted_cash":92.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 400 mcg/100 mL (4 mcg/mL) solution 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143952501","type":"NDC"}],"standard_charges":[{"gross_charge":87.32,"discounted_cash":21.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 100 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143953225","type":"NDC"}],"standard_charges":[{"gross_charge":39.37,"discounted_cash":9.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 200 mcg/50 mL (4 mcg/mL) solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409166050","type":"NDC"}],"standard_charges":[{"gross_charge":194.95,"discounted_cash":48.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric subsulfate 0.2 to 0.22 gram/mL solution with applicator 8 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"48783011308","type":"NDC"}],"standard_charges":[{"gross_charge":119.99,"discounted_cash":30.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vecuronium 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"409163221","type":"NDC"}],"standard_charges":[{"gross_charge":54.22,"discounted_cash":13.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vecuronium 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323078110","type":"NDC"}],"standard_charges":[{"gross_charge":93.59,"discounted_cash":23.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vecuronium 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335093140","type":"NDC"}],"standard_charges":[{"gross_charge":61.85,"discounted_cash":15.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vecuronium 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457043810","type":"NDC"}],"standard_charges":[{"gross_charge":95.37,"discounted_cash":23.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vecuronium 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457043800","type":"NDC"}],"standard_charges":[{"gross_charge":95.37,"discounted_cash":23.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vecuronium 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"41616093140","type":"NDC"}],"standard_charges":[{"gross_charge":18.85,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vecuronium 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"409163201","type":"NDC"}],"standard_charges":[{"gross_charge":54.22,"discounted_cash":13.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUFentanil 50 mcg/mL solution 5 mL AMPUL","drug_information":{"unit":0.04,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"17478005005","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUFentanil 50 mcg/mL solution 1 mL AMPUL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"17478005001","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"silver nitrate applicators 75-25 % stick 100 each Tube","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"12165010001","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"silver nitrate applicators 75-25 % stick 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"12870000101","type":"NDC"}],"standard_charges":[{"gross_charge":5.77,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"silver nitrate applicators 75-25 % stick 100 each Tube","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"12165010003","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409016110","type":"NDC"}],"standard_charges":[{"gross_charge":19.73,"discounted_cash":4.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409016101","type":"NDC"}],"standard_charges":[{"gross_charge":19.73,"discounted_cash":4.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71839014325","type":"NDC"}],"standard_charges":[{"gross_charge":22.83,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vecuronium 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323078121","type":"NDC"}],"standard_charges":[{"gross_charge":93.59,"discounted_cash":23.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trace elements comb no.1 5.33-0.34-0.54 mcg-mg-mg/mL solution 10 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323014397","type":"NDC"}],"standard_charges":[{"gross_charge":113.44,"discounted_cash":28.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488720","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488750","type":"NDC"}],"standard_charges":[{"gross_charge":13.41,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric subsulfate 0.2 to 0.22 gram/mL solution with applicator 8 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"48783011208","type":"NDC"}],"standard_charges":[{"gross_charge":149.46,"discounted_cash":37.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atracurium 10 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021067210","type":"NDC"}],"standard_charges":[{"gross_charge":88.86,"discounted_cash":22.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018550","type":"NDC"}],"standard_charges":[{"gross_charge":79.28,"discounted_cash":19.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018520","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018510","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"62135083384","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219018701","type":"NDC"}],"standard_charges":[{"gross_charge":78.9,"discounted_cash":19.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018508","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018507","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"641614710","type":"NDC"}],"standard_charges":[{"gross_charge":22.67,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"641614701","type":"NDC"}],"standard_charges":[{"gross_charge":22.67,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488723","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488725","type":"NDC"}],"standard_charges":[{"gross_charge":33.7,"discounted_cash":8.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488724","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488717","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488710","type":"NDC"}],"standard_charges":[{"gross_charge":9.42,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 100 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70860060503","type":"NDC"}],"standard_charges":[{"gross_charge":15.7,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexmedeTOMIDine 100 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70860060541","type":"NDC"}],"standard_charges":[{"gross_charge":15.7,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789001101","type":"NDC"}],"standard_charges":[{"gross_charge":0.7,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetic acid 5 % liquid 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51552005503","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetic acid 5 % liquid 500 mL Bottle","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51552005506","type":"NDC"}],"standard_charges":[{"gross_charge":35.24,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoflurane 99.9 % liquid 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"10019036040","type":"NDC"}],"standard_charges":[{"gross_charge":72.77,"discounted_cash":18.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoflurane 99.9 % liquid 250 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"66794001725","type":"NDC"}],"standard_charges":[{"gross_charge":220.23,"discounted_cash":55.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoflurane 99.9 % liquid 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"66794001710","type":"NDC"}],"standard_charges":[{"gross_charge":111.84,"discounted_cash":27.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin (adult) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"gross_charge":77.67,"discounted_cash":19.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin (adult) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"54643786201","type":"NDC"}],"standard_charges":[{"gross_charge":60.28,"discounted_cash":15.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine in 0.9% NaCl PF per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70092904205","type":"NDC"}],"standard_charges":[{"gross_charge":187.67,"discounted_cash":46.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol B22GK 4/0 solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571011106","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol B22GK 4/0 solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571011105","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine-D5W 16 mg/250 mL (64 mcg/mL) solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338011620","type":"NDC"}],"standard_charges":[{"gross_charge":484.5,"discounted_cash":121.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol BGK 4/0/1.2 solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571011406","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol BGK 4/0/1.2 solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571011405","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol BK 0/0/1.2 solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571011306","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol BK 0/0/1.2 solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571011305","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetic acid 5 % liquid 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710801108","type":"NDC"}],"standard_charges":[{"gross_charge":14.55,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 40 % (w/v) 29% (w/w) suspension 250 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"32909012207","type":"NDC"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":212.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water, bacteriostatic solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409397703","type":"NDC"}],"standard_charges":[{"gross_charge":14.48,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.25 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409904301","type":"NDC"}],"standard_charges":[{"gross_charge":46.34,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevoflurane 99.97 % liquid 250 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"74445604","type":"NDC"}],"standard_charges":[{"gross_charge":1363.48,"discounted_cash":340.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevoflurane 99.97 % liquid 250 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"66794001525","type":"NDC"}],"standard_charges":[{"gross_charge":471.09,"discounted_cash":117.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevoflurane 99.97 % liquid 250 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"10019065164","type":"NDC"}],"standard_charges":[{"gross_charge":356.19,"discounted_cash":89.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetic acid 3 % liquid 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710801008","type":"NDC"}],"standard_charges":[{"gross_charge":12.64,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetic acid 3 % liquid 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710800608","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetic acid 3 % liquid 500 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51552005106","type":"NDC"}],"standard_charges":[{"gross_charge":164.69,"discounted_cash":41.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710515601","type":"NDC"}],"standard_charges":[{"gross_charge":74.69,"discounted_cash":18.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046301","type":"NDC"}],"standard_charges":[{"gross_charge":194.18,"discounted_cash":48.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046357","type":"NDC"}],"standard_charges":[{"gross_charge":194.18,"discounted_cash":48.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409175550","type":"NDC"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":23.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409904601","type":"NDC"}],"standard_charges":[{"gross_charge":50.17,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.25 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710515501","type":"NDC"}],"standard_charges":[{"gross_charge":68.56,"discounted_cash":17.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.25 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046101","type":"NDC"}],"standard_charges":[{"gross_charge":181.16,"discounted_cash":45.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.25 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046157","type":"NDC"}],"standard_charges":[{"gross_charge":181.16,"discounted_cash":45.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine 0.25 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409175250","type":"NDC"}],"standard_charges":[{"gross_charge":82.35,"discounted_cash":20.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water, bacteriostatic solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409397701","type":"NDC"}],"standard_charges":[{"gross_charge":14.48,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine-D5W 4 mg/250 mL (16 mcg/mL) solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338011220","type":"NDC"}],"standard_charges":[{"gross_charge":164.69,"discounted_cash":41.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine-D5W 4 mg/250 mL (16 mcg/mL) solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"7219660561","type":"NDC"}],"standard_charges":[{"gross_charge":160.86,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine-D5W 4 mg/250 mL (16 mcg/mL) solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71285605601","type":"NDC"}],"standard_charges":[{"gross_charge":204.91,"discounted_cash":51.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cupric chloride 0.4 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409409211","type":"NDC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cupric chloride 0.4 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409409201","type":"NDC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":54.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for inject bact parabens solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323024930","type":"NDC"}],"standard_charges":[{"gross_charge":14.48,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021032401","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"83634030341","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"83634030301","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"23155066043","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"23155066031","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"69918073110","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"69918073101","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789001107","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 5 mL Vial","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789001507","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121160401","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 1 mL Vial","drug_information":{"unit":0.005,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"548950100","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 0.2 mg/mL solution 5 mL Vial","drug_information":{"unit":0.001,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789001505","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iodine strong (Lugols) 5 % solution 1 mL Syringe","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710219501","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iodine strong (Lugols) 5 % solution 14 mL Bottle","drug_information":{"unit":0.01786,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"48433023015","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydromorphone 10 mg/mL INTRATHECAL 20ml (IR use only) 10 mg/mL solution 20 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710513101","type":"NDC"}],"standard_charges":[{"gross_charge":170.21,"discounted_cash":42.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydromorphone 10 mg/mL INTRATHECAL 40ml (IR use only) 10 mg/mL solution 40 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710513201","type":"NDC"}],"standard_charges":[{"gross_charge":340.41,"discounted_cash":85.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine in 0.9 % NaCl 50 mg/5 mL (10 mg/mL) syringe 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70092911944","type":"NDC"}],"standard_charges":[{"gross_charge":53.77,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine in 0.9 % NaCl 50 mg/5 mL (10 mg/mL) syringe 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70092111944","type":"NDC"}],"standard_charges":[{"gross_charge":34.47,"discounted_cash":8.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol BGK 0/2.5 solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571010806","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol BGK 0/2.5 solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571010805","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol BGK 2/0 K (2 mEq/L) -Mg (1 mEq/L) solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571010205","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amino acid 6% 6 % parenteral solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338113103","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amino acids 10% 10 % parenteral solution 2,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338064406","type":"NDC"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":50.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71839014301","type":"NDC"}],"standard_charges":[{"gross_charge":22.83,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amino acids 10 % parenteral solution 2,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409717217","type":"NDC"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":50.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin (pediatric) 80 mg-400 unit- 200 mcg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"54643564601","type":"NDC"}],"standard_charges":[{"gross_charge":141.6,"discounted_cash":35.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"candida albicans skin test FDA STANDARD allergen 0.1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710507801","type":"NDC"}],"standard_charges":[{"gross_charge":107.57,"discounted_cash":26.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"candida albicans skin test FDA STANDARD allergen 1 mL Vial","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"59584013801","type":"NDC"}],"standard_charges":[{"gross_charge":233.45,"discounted_cash":58.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 60 % (w/v) suspension 355 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"32909018602","type":"NDC"}],"standard_charges":[{"gross_charge":131.22,"discounted_cash":32.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc oxide 4 X 10 \"-yard bandage 1 each Package","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10356010302","type":"NDC"}],"standard_charges":[{"gross_charge":46.34,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trace elements ped Cr-Cu-Mn-Zn 1 mcg-0.1 mg-30 mcg-0.5 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"517931025","type":"NDC"}],"standard_charges":[{"gross_charge":53.7,"discounted_cash":13.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 1 mEq/mL (8.4 %) solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70095005001","type":"NDC"}],"standard_charges":[{"gross_charge":38.3,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"poractant alfa 240 mg/3 mL suspension 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"10122051003","type":"NDC"}],"standard_charges":[{"gross_charge":8434.58,"discounted_cash":2108.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"47335061544","type":"NDC"}],"standard_charges":[{"gross_charge":172.17,"discounted_cash":43.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"47335061540","type":"NDC"}],"standard_charges":[{"gross_charge":172.17,"discounted_cash":43.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51991098399","type":"NDC"}],"standard_charges":[{"gross_charge":28.43,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated ringers amnioinfusion solution 1,000 mL Bag","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338011704","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated ringers amnioinfusion solution 500 mL Bag","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338011703","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated ringers amnioinfusion solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338011702","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 250 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338954201","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Bag","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"264999910","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 1,000 mL Flex Cont","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"264780009","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 100 mL Bag","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004948","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 50 mL Bag","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004941","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 100 mL Bag","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004918","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":7.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 50 mL Bag","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004911","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 1,000 mL Bag","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"338004904","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Bag","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"338004903","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004902","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Bag","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"338630403","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 250 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"264780020","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride amnioinfusion per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"264180031","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"264780010","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride amnioinfusion per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"264180032","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated ringers amnioinfusion solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"338011704","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated ringers amnioinfusion solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"338011703","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated ringers amnioinfusion solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"338011702","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"264999910","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"264780009","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004948","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004941","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004918","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004911","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"338004904","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"338004903","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"338630403","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride amnioinfusion per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"264780000","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride amnioinfusion per 1000 mL","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"264780000","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride amnioinfusion per 1000 mL","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"264180032","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride amnioinfusion per 1000 mL","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"264180031","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diatrizoate meglumine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"270141030","type":"NDC"}],"standard_charges":[{"gross_charge":1020.0,"discounted_cash":255.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iopamidol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"270131530","type":"NDC"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":42.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iodixanol per 1 mL","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"407222321","type":"NDC"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":42.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iodixanol per 1 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"407222317","type":"NDC"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":42.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iodixanol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"407222316","type":"NDC"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":42.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iohexol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"407141361","type":"NDC"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":42.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iopamidol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"270131630","type":"NDC"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":42.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iopamidol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"270141215","type":"NDC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":12.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iohexol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"407141472","type":"NDC"}],"standard_charges":[{"gross_charge":1700.0,"discounted_cash":425.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iohexol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"407141491","type":"NDC"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":85.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iohexol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"42852000419","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iohexol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"407141220","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":17.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iopamidol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"270141125","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":17.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diatrizoate meglumine-sodium per 1 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"270044540","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":51.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diatrizoate meglumine-sodium per 1 mL","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"19481604","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":51.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Radium ra-223 dichloride, therapeutic, per microcurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"344","type":"RC"},{"code":"A9606","type":"HCPCS"},{"code":"50419020801","type":"NDC"}],"standard_charges":[{"gross_charge":1014.12,"discounted_cash":253.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MICROCURIE"}]},{"description":"Lutetium lu 177, dotatate, therapeutic, 1 millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"344","type":"RC"},{"code":"A9513","type":"HCPCS"},{"code":"69488000301","type":"NDC"}],"standard_charges":[{"gross_charge":1794.24,"discounted_cash":448.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"344","type":"RC"},{"code":"A9607","type":"HCPCS"},{"code":"69488001061","type":"NDC"}],"standard_charges":[{"gross_charge":1461.12,"discounted_cash":365.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"dextrose in water 10 % parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"264752000","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"electrolyte-A parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338959310","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"electrolyte-A parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338959301","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"electrolyte-A parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338022104","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 10 % in water 10% solution 1,000 mL Bag","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338002304","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 10 % in water 10% solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338002302","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and lactated Ringer's 5 % solution 1,000 mL Bag","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338012504","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and lactated Ringer's 5 % solution 500 mL Bag","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338012503","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.45 % parenteral solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338004303","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.45 % solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338004304","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose in water 10 % parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"97710524105","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose in water 10 % parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"97710524005","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose in water 10 % parenteral solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"97710517403","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose in water 10 % parenteral solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"97710517303","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 10 % in water 10% solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338002304","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose in water 10 % parenteral solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"264752020","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hypochlorite 0.25 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"436093616","type":"NDC"}],"standard_charges":[{"gross_charge":137.68,"discounted_cash":34.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.45 % parenteral solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"264580400","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046204","type":"NDC"}],"standard_charges":[{"gross_charge":73.23,"discounted_cash":18.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046201","type":"NDC"}],"standard_charges":[{"gross_charge":121.79,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409904516","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409174971","type":"NDC"}],"standard_charges":[{"gross_charge":43.2,"discounted_cash":10.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409174970","type":"NDC"}],"standard_charges":[{"gross_charge":36.61,"discounted_cash":9.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046217","type":"NDC"}],"standard_charges":[{"gross_charge":73.23,"discounted_cash":18.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409904517","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046237","type":"NDC"}],"standard_charges":[{"gross_charge":121.79,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046231","type":"NDC"}],"standard_charges":[{"gross_charge":63.88,"discounted_cash":15.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409174910","type":"NDC"}],"standard_charges":[{"gross_charge":36.61,"discounted_cash":9.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"microfibrillar collagen powder 1 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"250","type":"RC"},{"code":"53276101002","type":"NDC"}],"standard_charges":[{"gross_charge":2178.5,"discounted_cash":544.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710518801","type":"NDC"}],"standard_charges":[{"gross_charge":80.89,"discounted_cash":20.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710518601","type":"NDC"}],"standard_charges":[{"gross_charge":134.82,"discounted_cash":33.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046801","type":"NDC"}],"standard_charges":[{"gross_charge":71.47,"discounted_cash":17.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046802","type":"NDC"}],"standard_charges":[{"gross_charge":113.06,"discounted_cash":28.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046202","type":"NDC"}],"standard_charges":[{"gross_charge":63.88,"discounted_cash":15.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409904216","type":"NDC"}],"standard_charges":[{"gross_charge":27.12,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710518701","type":"NDC"}],"standard_charges":[{"gross_charge":163.54,"discounted_cash":40.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 96 % enema 397 g KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"250","type":"RC"},{"code":"32909080401","type":"NDC"}],"standard_charges":[{"gross_charge":252.17,"discounted_cash":63.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51991098317","type":"NDC"}],"standard_charges":[{"gross_charge":28.43,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021031604","type":"NDC"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"703115383","type":"NDC"}],"standard_charges":[{"gross_charge":42.07,"discounted_cash":10.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"703115381","type":"NDC"}],"standard_charges":[{"gross_charge":42.07,"discounted_cash":10.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409337514","type":"NDC"}],"standard_charges":[{"gross_charge":20.04,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121157607","type":"NDC"}],"standard_charges":[{"gross_charge":30.39,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70121157601","type":"NDC"}],"standard_charges":[{"gross_charge":30.39,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"781375595","type":"NDC"}],"standard_charges":[{"gross_charge":25.37,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"781375575","type":"NDC"}],"standard_charges":[{"gross_charge":25.37,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457085204","type":"NDC"}],"standard_charges":[{"gross_charge":42.96,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457085200","type":"NDC"}],"standard_charges":[{"gross_charge":42.96,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"703115303","type":"NDC"}],"standard_charges":[{"gross_charge":172.17,"discounted_cash":43.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"703115301","type":"NDC"}],"standard_charges":[{"gross_charge":172.17,"discounted_cash":43.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"36000016201","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norepinephrine 1 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409337504","type":"NDC"}],"standard_charges":[{"gross_charge":20.04,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine (PF) 0.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710518901","type":"NDC"}],"standard_charges":[{"gross_charge":98.12,"discounted_cash":24.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409174671","type":"NDC"}],"standard_charges":[{"gross_charge":70.55,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409174670","type":"NDC"}],"standard_charges":[{"gross_charge":33.93,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409904217","type":"NDC"}],"standard_charges":[{"gross_charge":27.12,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PrismaSol BGK 4/2.5 solution 5,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24571010506","type":"NDC"}],"standard_charges":[{"gross_charge":421.3,"discounted_cash":105.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emulsion 20 % emulsion 250 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219053325","type":"NDC"}],"standard_charges":[{"gross_charge":109.16,"discounted_cash":27.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emulsion 20 % emulsion 250 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219053301","type":"NDC"}],"standard_charges":[{"gross_charge":109.16,"discounted_cash":27.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emulsion 20 % emulsion 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219053110","type":"NDC"}],"standard_charges":[{"gross_charge":90.39,"discounted_cash":22.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emulsion 20 % emulsion 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219053101","type":"NDC"}],"standard_charges":[{"gross_charge":90.39,"discounted_cash":22.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emulsion 20 % emulsion 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710516503","type":"NDC"}],"standard_charges":[{"gross_charge":74.69,"discounted_cash":18.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emulsion 20 % emulsion 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338051958","type":"NDC"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":20.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emulsion 20 % emulsion 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338051913","type":"NDC"}],"standard_charges":[{"gross_charge":160.86,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emulsion 20 % emulsion 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338051909","type":"NDC"}],"standard_charges":[{"gross_charge":118.73,"discounted_cash":29.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine 10 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323073809","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethiodized oiL 480 mg iodine/mL oil 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"255","type":"RC"},{"code":"67684190102","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and lactated Ringer's 5 % solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338012504","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and lactated Ringer's 5 % solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"338012503","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and lactated Ringer's parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"264775100","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.45 % parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"97710523205","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 500 mg/5 mL (10 %) solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65009265","type":"NDC"}],"standard_charges":[{"gross_charge":343.32,"discounted_cash":85.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 500 mg/5 mL (10 %) solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789012205","type":"NDC"}],"standard_charges":[{"gross_charge":347.99,"discounted_cash":87.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 500 mg/5 mL (10 %) solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789012207","type":"NDC"}],"standard_charges":[{"gross_charge":347.99,"discounted_cash":87.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 500 mg/5 mL (10 %) solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"81298866001","type":"NDC"}],"standard_charges":[{"gross_charge":380.63,"discounted_cash":95.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046837","type":"NDC"}],"standard_charges":[{"gross_charge":113.06,"discounted_cash":28.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323046817","type":"NDC"}],"standard_charges":[{"gross_charge":71.47,"discounted_cash":17.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409174610","type":"NDC"}],"standard_charges":[{"gross_charge":33.93,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine-EPINEPHrine PF 0.25 %-1:200,000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409174630","type":"NDC"}],"standard_charges":[{"gross_charge":70.55,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 40 % (w/v), 30% (w/w) paste 230 mL Tube","drug_information":{"unit":0.26087,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"32909012522","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":51.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68382047001","type":"NDC"}],"standard_charges":[{"gross_charge":3049.52,"discounted_cash":762.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"409111301","type":"NDC"}],"standard_charges":[{"gross_charge":1423.99,"discounted_cash":356.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.45 % parenteral solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"258","type":"RC"},{"code":"97710522802","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323065994","type":"NDC"}],"standard_charges":[{"gross_charge":2520.06,"discounted_cash":630.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indocyanine green 25 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70100082502","type":"NDC"}],"standard_charges":[{"gross_charge":2199.2,"discounted_cash":549.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indocyanine green 25 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70100072501","type":"NDC"}],"standard_charges":[{"gross_charge":2199.2,"discounted_cash":549.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indocyanine green 25 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70100042402","type":"NDC"}],"standard_charges":[{"gross_charge":1744.63,"discounted_cash":436.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indocyanine green 25 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70100042401","type":"NDC"}],"standard_charges":[{"gross_charge":1744.63,"discounted_cash":436.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 700 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10361077831","type":"NDC"}],"standard_charges":[{"gross_charge":23.05,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 500 mg/5 mL (10 %) solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"17478025310","type":"NDC"}],"standard_charges":[{"gross_charge":512.22,"discounted_cash":128.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein 500 mg/5 mL (10 %) solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"81298866003","type":"NDC"}],"standard_charges":[{"gross_charge":380.63,"discounted_cash":95.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323065903","type":"NDC"}],"standard_charges":[{"gross_charge":2847.91,"discounted_cash":711.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hypochlorite 0.25 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"39328006325","type":"NDC"}],"standard_charges":[{"gross_charge":112.32,"discounted_cash":28.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cisatracurium 10 mg/mL conc. (ICU USE ONLY) solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71288071320","type":"NDC"}],"standard_charges":[{"gross_charge":218.16,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cisatracurium 10 mg/mL conc. (ICU USE ONLY) solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71288071321","type":"NDC"}],"standard_charges":[{"gross_charge":218.16,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409490264","type":"NDC"}],"standard_charges":[{"gross_charge":132.14,"discounted_cash":33.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409664816","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710514201","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70092147550","type":"NDC"}],"standard_charges":[{"gross_charge":115.28,"discounted_cash":28.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710500301","type":"NDC"}],"standard_charges":[{"gross_charge":26.04,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"76329330101","type":"NDC"}],"standard_charges":[{"gross_charge":82.73,"discounted_cash":20.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409751716","type":"NDC"}],"standard_charges":[{"gross_charge":129.07,"discounted_cash":32.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409490234","type":"NDC"}],"standard_charges":[{"gross_charge":132.14,"discounted_cash":33.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409664802","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.45 % flush 4 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710518101","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitrite 30 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"60267031110","type":"NDC"}],"standard_charges":[{"gross_charge":758.34,"discounted_cash":189.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409751766","type":"NDC"}],"standard_charges":[{"gross_charge":129.07,"discounted_cash":32.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emul-soy-mct-oliv-fish oil 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323082001","type":"NDC"}],"standard_charges":[{"gross_charge":166.99,"discounted_cash":41.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"gross_charge":128.31,"discounted_cash":32.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409490024","type":"NDC"}],"standard_charges":[{"gross_charge":178.32,"discounted_cash":44.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF 5 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409230801","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF 50 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409909422","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride PF 0.9 % solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018610","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE 5 mg/1 mL injectable 1 mL Syringe","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710507601","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution (High Potassium) 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710519205","type":"NDC"}],"standard_charges":[{"gross_charge":428.96,"discounted_cash":107.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 5 mg/mL solution 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789025210","type":"NDC"}],"standard_charges":[{"gross_charge":152.28,"discounted_cash":38.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 5 mg/mL solution 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789025209","type":"NDC"}],"standard_charges":[{"gross_charge":152.28,"discounted_cash":38.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 5 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023024301","type":"NDC"}],"standard_charges":[{"gross_charge":74.69,"discounted_cash":18.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 5 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789025010","type":"NDC"}],"standard_charges":[{"gross_charge":74.61,"discounted_cash":18.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 5 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789025007","type":"NDC"}],"standard_charges":[{"gross_charge":74.61,"discounted_cash":18.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine in 0.9 % sod chloride 1 mg/ mL solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710520803","type":"NDC"}],"standard_charges":[{"gross_charge":45.96,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution (del Nido) 26 mEq/1,049.5mL (potassium) solution 1,049.5 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710516705","type":"NDC"}],"standard_charges":[{"gross_charge":96.47,"discounted_cash":24.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754501104","type":"NDC"}],"standard_charges":[{"gross_charge":67.33,"discounted_cash":16.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754501101","type":"NDC"}],"standard_charges":[{"gross_charge":67.33,"discounted_cash":16.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710517101","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emul-soy-mct-oliv-fish oil 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323082000","type":"NDC"}],"standard_charges":[{"gross_charge":166.99,"discounted_cash":41.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium thiosulfate 12.5 gram/50 mL solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"gross_charge":758.34,"discounted_cash":189.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flumazenil 0.1 mg/mL solution 5 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143978401","type":"NDC"}],"standard_charges":[{"gross_charge":12.93,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flumazenil 0.1 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457044700","type":"NDC"}],"standard_charges":[{"gross_charge":26.24,"discounted_cash":6.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flumazenil 0.1 mg/mL solution 5 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143978410","type":"NDC"}],"standard_charges":[{"gross_charge":12.93,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flumazenil 0.1 mg/mL solution 5 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323042405","type":"NDC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile talc 5 gram suspension for reconstitution 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63256020005","type":"NDC"}],"standard_charges":[{"gross_charge":76.22,"discounted_cash":19.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aluminum potassium powder 10 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"250","type":"RC"},{"code":"24357030030","type":"NDC"}],"standard_charges":[{"gross_charge":5075.29,"discounted_cash":1268.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentian violet 1 % solution 59 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"395100392","type":"NDC"}],"standard_charges":[{"gross_charge":30.73,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hyaluronate 23 mg/mL syringe 0.6 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"85445008321","type":"NDC"}],"standard_charges":[{"gross_charge":843.75,"discounted_cash":210.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL-BUPivacaine in NS (PF) 2 mcg/mL- 0.125 % solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710514403","type":"NDC"}],"standard_charges":[{"gross_charge":42.13,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL-BUPivacaine in NS (PF) 2 mcg/mL- 0.125 % solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70092150137","type":"NDC"}],"standard_charges":[{"gross_charge":243.21,"discounted_cash":60.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL-BUPivacaine in NS (PF) 2 mcg/mL- 0.125 % solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70092110537","type":"NDC"}],"standard_charges":[{"gross_charge":256.61,"discounted_cash":64.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution 16 mEq/L (= K+) solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409796911","type":"NDC"}],"standard_charges":[{"gross_charge":390.66,"discounted_cash":97.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution 16 mEq/L (= K+) solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338034104","type":"NDC"}],"standard_charges":[{"gross_charge":321.72,"discounted_cash":80.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution 16 mEq/L (= K+) solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409796905","type":"NDC"}],"standard_charges":[{"gross_charge":390.66,"discounted_cash":97.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chondroitin sulf-sod hyaluron 4-3 % (40-30 mg/mL) syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"8065183905","type":"NDC"}],"standard_charges":[{"gross_charge":285.11,"discounted_cash":71.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flumazenil 0.1 mg/mL solution 5 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"36000014801","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 40 % (w/v) suspension 240 mL Bottle","drug_information":{"unit":0.08333,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"32909011500","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":17.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin in dextrose 5% in water 12 mg/mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"781328909","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin in dextrose 5% in water 12 mg/mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"781328991","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409662522","type":"NDC"}],"standard_charges":[{"gross_charge":63.2,"discounted_cash":15.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409662514","type":"NDC"}],"standard_charges":[{"gross_charge":63.2,"discounted_cash":15.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409663724","type":"NDC"}],"standard_charges":[{"gross_charge":128.31,"discounted_cash":32.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754500105","type":"NDC"}],"standard_charges":[{"gross_charge":39.07,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754500101","type":"NDC"}],"standard_charges":[{"gross_charge":39.83,"discounted_cash":9.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323008950","type":"NDC"}],"standard_charges":[{"gross_charge":43.66,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 8.4 % (1 mEq/mL) syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"76329335201","type":"NDC"}],"standard_charges":[{"gross_charge":129.45,"discounted_cash":32.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF 5 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021065601","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 4.2 % (0.5 mEq/mL) syringe 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754501204","type":"NDC"}],"standard_charges":[{"gross_charge":69.17,"discounted_cash":17.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 4.2 % (0.5 mEq/mL) syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409553424","type":"NDC"}],"standard_charges":[{"gross_charge":120.26,"discounted_cash":30.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 4.2 % (0.5 mEq/mL) syringe 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409555512","type":"NDC"}],"standard_charges":[{"gross_charge":34.28,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 4.2 % (0.5 mEq/mL) syringe 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409555502","type":"NDC"}],"standard_charges":[{"gross_charge":34.28,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 4.2 % (0.5 mEq/mL) syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409553434","type":"NDC"}],"standard_charges":[{"gross_charge":69.63,"discounted_cash":17.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyaluronidase ovine 200 unit/mL solution 1.2 mL Vial","drug_information":{"unit":0.83333,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J3470","type":"HCPCS"},{"code":"24208000201","type":"NDC"}],"standard_charges":[{"gross_charge":399.79,"discounted_cash":99.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin in dextrose 5% in water 12 mg/mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338361650","type":"NDC"}],"standard_charges":[{"gross_charge":31.79,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin in dextrose 5% in water 12 mg/mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338361250","type":"NDC"}],"standard_charges":[{"gross_charge":209.12,"discounted_cash":52.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 4.2 % (0.5 mEq/mL) syringe 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754501201","type":"NDC"}],"standard_charges":[{"gross_charge":69.17,"discounted_cash":17.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chondroitin sulf-sod hyaluron 3 %-4 %(0.5 mL) 1 % (0.55 mL) syringe 1.05 mL KIT","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"8065183150","type":"NDC"}],"standard_charges":[{"gross_charge":446.8,"discounted_cash":111.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bevacizumab 25 mg/mL solution 4 mL Vial","drug_information":{"unit":0.075,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"50242006001","type":"NDC"}],"standard_charges":[{"gross_charge":456.7,"discounted_cash":114.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ammonia 15 % (w/v) solution 1 each AMPUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"46414333303","type":"NDC"}],"standard_charges":[{"gross_charge":9.57,"discounted_cash":2.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % solution 4 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"76329630005","type":"NDC"}],"standard_charges":[{"gross_charge":270.55,"discounted_cash":67.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cysteine (L-Cysteine) 50 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754100703","type":"NDC"}],"standard_charges":[{"gross_charge":717.97,"discounted_cash":179.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 50 mg/mL solution 1 mL Syringe","drug_information":{"unit":50.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710518001","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 50 mg/mL solution 10 mL Vial","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150043910","type":"NDC"}],"standard_charges":[{"gross_charge":27.96,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 50 mg/mL solution 10 mL Vial","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150043901","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 50 mg/mL solution 2 mL Syringe","drug_information":{"unit":100.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710513001","type":"NDC"}],"standard_charges":[{"gross_charge":13.44,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 50 mg/mL solution 10 mL Vial","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143950810","type":"NDC"}],"standard_charges":[{"gross_charge":55.08,"discounted_cash":13.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 50 mg/mL solution 10 mL Vial","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143950801","type":"NDC"}],"standard_charges":[{"gross_charge":55.08,"discounted_cash":13.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 50 mg/mL solution 10 mL Vial","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457000100","type":"NDC"}],"standard_charges":[{"gross_charge":67.18,"discounted_cash":16.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 50 mg/mL solution 10 mL Vial","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023011410","type":"NDC"}],"standard_charges":[{"gross_charge":50.86,"discounted_cash":12.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 50 mg/mL solution 10 mL Vial","drug_information":{"unit":500.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457000110","type":"NDC"}],"standard_charges":[{"gross_charge":67.18,"discounted_cash":16.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 100 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143950910","type":"NDC"}],"standard_charges":[{"gross_charge":69.51,"discounted_cash":17.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 100 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143950901","type":"NDC"}],"standard_charges":[{"gross_charge":69.51,"discounted_cash":17.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219018401","type":"NDC"}],"standard_charges":[{"gross_charge":93.15,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ammonia 15 % (w/v) solution 1 each AMPUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822990001","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021068220","type":"NDC"}],"standard_charges":[{"gross_charge":72.16,"discounted_cash":18.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ammonia 15 % (w/v) solution 1 each AMPUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822990002","type":"NDC"}],"standard_charges":[{"gross_charge":2.7,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G sodium 5 million unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"781615394","type":"NDC"}],"standard_charges":[{"gross_charge":317.37,"discounted_cash":79.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium acetate 2 mEq/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409818311","type":"NDC"}],"standard_charges":[{"gross_charge":28.04,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium acetate 2 mEq/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754200104","type":"NDC"}],"standard_charges":[{"gross_charge":49.94,"discounted_cash":12.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium acetate 2 mEq/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409818301","type":"NDC"}],"standard_charges":[{"gross_charge":28.04,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"143946101","type":"NDC"}],"standard_charges":[{"gross_charge":35.68,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"143946110","type":"NDC"}],"standard_charges":[{"gross_charge":35.68,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323032101","type":"NDC"}],"standard_charges":[{"gross_charge":38.42,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323036744","type":"NDC"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":7.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323036741","type":"NDC"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":7.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323036701","type":"NDC"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":7.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70594004902","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70594004901","type":"NDC"}],"standard_charges":[{"gross_charge":35.65,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150023410","type":"NDC"}],"standard_charges":[{"gross_charge":25.38,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323036711","type":"NDC"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":7.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polymyxin B 500,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822017001","type":"NDC"}],"standard_charges":[{"gross_charge":81.87,"discounted_cash":20.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"physostigmine 1 mg/mL solution 2 mL AMPUL","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"17478051002","type":"NDC"}],"standard_charges":[{"gross_charge":151.42,"discounted_cash":37.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole nitrate 2% 2 % aerosol,spray 2 oz Spray Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69502050057","type":"NDC"}],"standard_charges":[{"gross_charge":24.99,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 OZ"}]},{"description":"ketamine 10 mg/mL solution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710418401","type":"NDC"}],"standard_charges":[{"gross_charge":33.4,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150043810","type":"NDC"}],"standard_charges":[{"gross_charge":112.6,"discounted_cash":28.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150043801","type":"NDC"}],"standard_charges":[{"gross_charge":112.6,"discounted_cash":28.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water Injectable Solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710523704","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 50 % in water Injectable Solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710523603","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amino acids 15 % parenteral solution 1,000 mL Glass Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"264320055","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amino acids 15 % parenteral solution 2,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338050206","type":"NDC"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":50.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rocuronium 10 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457022805","type":"NDC"}],"standard_charges":[{"gross_charge":34.13,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isoproterenol 4 mcg/mL solution 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710510201","type":"NDC"}],"standard_charges":[{"gross_charge":2033.35,"discounted_cash":508.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione (vitamin K1) 10 mg/mL solution 1 mL AMPUL","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710215801","type":"NDC"}],"standard_charges":[{"gross_charge":8.91,"discounted_cash":2.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione (vitamin K1) 10 mg/mL solution 1 mL AMPUL","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710213501","type":"NDC"}],"standard_charges":[{"gross_charge":18.57,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 5 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"641606101","type":"NDC"}],"standard_charges":[{"gross_charge":4.28,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 5 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710800901","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 5 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710801201","type":"NDC"}],"standard_charges":[{"gross_charge":27.42,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488810","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 2 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710513701","type":"NDC"}],"standard_charges":[{"gross_charge":13.68,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 2 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710513601","type":"NDC"}],"standard_charges":[{"gross_charge":18.48,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710513501","type":"NDC"}],"standard_charges":[{"gross_charge":68.4,"discounted_cash":17.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710513401","type":"NDC"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":23.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457018100","type":"NDC"}],"standard_charges":[{"gross_charge":184.76,"discounted_cash":46.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023011310","type":"NDC"}],"standard_charges":[{"gross_charge":83.34,"discounted_cash":20.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium tetradecyl sulfate 3 % (30 mg/mL) solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457016300","type":"NDC"}],"standard_charges":[{"gross_charge":598.51,"discounted_cash":149.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium tetradecyl sulfate 3 % (30 mg/mL) solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457016302","type":"NDC"}],"standard_charges":[{"gross_charge":598.51,"discounted_cash":149.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018602","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018604","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488806","type":"NDC"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488803","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488801","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409488802","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323018620","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium iodide 1 gram/mL solution 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710220201","type":"NDC"}],"standard_charges":[{"gross_charge":71.18,"discounted_cash":17.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hyaluronate 10 mg/mL syringe 0.85 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"50474080744","type":"NDC"}],"standard_charges":[{"gross_charge":1019.16,"discounted_cash":254.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hyaluronate 10 mg/mL syringe 0.85 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"85446036981","type":"NDC"}],"standard_charges":[{"gross_charge":1014.95,"discounted_cash":253.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citrate dextrose solution 2.45-2.2 gram- 800 mg/100 mL solution 750 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14537081775","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 40 %(w/v), 29% (w/w)(1500 CPS) suspension 250 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"32909012107","type":"NDC"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":212.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethanol (ethyl alcohol) 99 % solution 5 mL Vial","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"83634030641","type":"NDC"}],"standard_charges":[{"gross_charge":13130.31,"discounted_cash":3282.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethanol (ethyl alcohol) 99 % solution 5 mL Vial","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"83634030605","type":"NDC"}],"standard_charges":[{"gross_charge":13130.31,"discounted_cash":3282.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethanol (ethyl alcohol) 99 % solution 5 mL AMPUL","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"54288010515","type":"NDC"}],"standard_charges":[{"gross_charge":24360.64,"discounted_cash":6090.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethanol (ethyl alcohol) 99 % solution 5 mL AMPUL","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"54288010502","type":"NDC"}],"standard_charges":[{"gross_charge":24360.64,"discounted_cash":6090.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile talc 3 gram aerosol powder 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327033343","type":"NDC"}],"standard_charges":[{"gross_charge":1168.15,"discounted_cash":292.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile talc 3 gram aerosol powder 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327033303","type":"NDC"}],"standard_charges":[{"gross_charge":1168.15,"discounted_cash":292.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid (vitamin C) 500 mg/mL solution 50 mL Vial","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67157010150","type":"NDC"}],"standard_charges":[{"gross_charge":39.23,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine-epi-clonid-ketorol (R.E.C.K.) 2.46-0.005- 0.0008-0.3mg/mL syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710516401","type":"NDC"}],"standard_charges":[{"gross_charge":56.68,"discounted_cash":14.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine-epi-clonid-ketorol (R.E.C.K.) 2.46-0.005- 0.0008-0.3mg/mL syringe 50 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70092143350","type":"NDC"}],"standard_charges":[{"gross_charge":408.28,"discounted_cash":102.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-phenylephrin-BSS(PF) 1-1.5 % syringe 1 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71266636001","type":"NDC"}],"standard_charges":[{"gross_charge":52.2,"discounted_cash":13.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 2 % (w/v) suspension 450 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"32909071103","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mvi, adult no.4, vit K, 1 of 2 3,300 unit- 150 mcg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"54643565701","type":"NDC"}],"standard_charges":[{"gross_charge":38.84,"discounted_cash":9.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sarilumab 200 mg/1.14 mL syringe 1.14 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24591000","type":"NDC"}],"standard_charges":[{"gross_charge":11978.79,"discounted_cash":2994.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hyaluronate 30 mg/mL syringe 0.85 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"50474054706","type":"NDC"}],"standard_charges":[{"gross_charge":518.74,"discounted_cash":129.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sarilumab 200 mg/1.14 mL syringe 1.14 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"24591001","type":"NDC"}],"standard_charges":[{"gross_charge":17191.41,"discounted_cash":4297.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amino acids 15 % parenteral solution 2,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"264450005","type":"NDC"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":50.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution (del Nido) 29 mmol/L (potassium) solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"69374098410","type":"NDC"}],"standard_charges":[{"gross_charge":1072.4,"discounted_cash":268.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 2 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72078003502","type":"NDC"}],"standard_charges":[{"gross_charge":698.05,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 2 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72078003500","type":"NDC"}],"standard_charges":[{"gross_charge":698.05,"discounted_cash":174.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 2 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323072405","type":"NDC"}],"standard_charges":[{"gross_charge":632.29,"discounted_cash":158.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 2 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323072401","type":"NDC"}],"standard_charges":[{"gross_charge":632.29,"discounted_cash":158.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 2 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457019899","type":"NDC"}],"standard_charges":[{"gross_charge":685.51,"discounted_cash":171.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72078003401","type":"NDC"}],"standard_charges":[{"gross_charge":357.76,"discounted_cash":89.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72078003400","type":"NDC"}],"standard_charges":[{"gross_charge":357.76,"discounted_cash":89.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323072306","type":"NDC"}],"standard_charges":[{"gross_charge":285.11,"discounted_cash":71.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323072304","type":"NDC"}],"standard_charges":[{"gross_charge":285.11,"discounted_cash":71.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323072303","type":"NDC"}],"standard_charges":[{"gross_charge":290.01,"discounted_cash":72.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323072301","type":"NDC"}],"standard_charges":[{"gross_charge":290.01,"discounted_cash":72.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remifentaniL 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457019800","type":"NDC"}],"standard_charges":[{"gross_charge":351.33,"discounted_cash":87.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trace elements 0.85 mcg-0.1 mg -25mcg-1.5mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"517620225","type":"NDC"}],"standard_charges":[{"gross_charge":79.07,"discounted_cash":19.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trace elements 1 mcg-0.1 mg-25 mcg-1 mg/mL solution 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"517920325","type":"NDC"}],"standard_charges":[{"gross_charge":82.91,"discounted_cash":20.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution (del Nido) 29 mmol/L (potassium) solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710522705","type":"NDC"}],"standard_charges":[{"gross_charge":1072.4,"discounted_cash":268.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 20 mcg/mL solution 5 mL Vial","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323088510","type":"NDC"}],"standard_charges":[{"gross_charge":129.34,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 10%+Trophamine 3.5%+Ca Gluconate 0.0093mEq/mL+HEParin PF 0.5 units/mL 3.5 %-10 %- 2.33 mEq/250 mL parenteral solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710522303","type":"NDC"}],"standard_charges":[{"gross_charge":413.64,"discounted_cash":103.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 10%+Trophamine 3.5%+Ca Gluconate 0.0093mEq/mL+HEParin PF 0.5 units/mL 3.5 %-10 %- 2.33 mEq/250 mL parenteral solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"72196042901","type":"NDC"}],"standard_charges":[{"gross_charge":390.66,"discounted_cash":97.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 10%+Trophamine 3.5%+Ca Gluconate 0.0093mEq/mL+HEParin PF 0.5 units/mL 3.5 %-10 %- 2.33 mEq/250 mL parenteral solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71285042901","type":"NDC"}],"standard_charges":[{"gross_charge":432.79,"discounted_cash":108.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution (del Nido) 26 mEq/1,052.8 mL (potassium) solution 1,052.8 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71285020201","type":"NDC"}],"standard_charges":[{"gross_charge":80.64,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sugammadex 100 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"6542312","type":"NDC"}],"standard_charges":[{"gross_charge":987.01,"discounted_cash":246.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sugammadex 100 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"6542302","type":"NDC"}],"standard_charges":[{"gross_charge":987.01,"discounted_cash":246.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cocaine 4 % solution 4 mL Bottle","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"81665030002","type":"NDC"}],"standard_charges":[{"gross_charge":756.45,"discounted_cash":189.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cocaine 4 % solution 4 mL Bottle","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70839036204","type":"NDC"}],"standard_charges":[{"gross_charge":634.06,"discounted_cash":158.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cocaine 4 % solution 4 mL Bottle","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"81665030102","type":"NDC"}],"standard_charges":[{"gross_charge":676.65,"discounted_cash":169.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cocaine 4 % solution 4 mL Bottle","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"527197174","type":"NDC"}],"standard_charges":[{"gross_charge":375.68,"discounted_cash":93.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cocaine 4 % solution 4 mL Bottle","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"64950036204","type":"NDC"}],"standard_charges":[{"gross_charge":401.27,"discounted_cash":100.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"idaruCIZUmab 2.5 gram/50 mL solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"597019705","type":"NDC"}],"standard_charges":[{"gross_charge":19395.89,"discounted_cash":4848.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"varicella-zoster i.glob-maltos 125 unit/1.2 mL solution 1.2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70257012651","type":"NDC"}],"standard_charges":[{"gross_charge":16718.48,"discounted_cash":4179.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"varicella-zoster i.glob-maltos 125 unit/1.2 mL solution 1.2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70257012611","type":"NDC"}],"standard_charges":[{"gross_charge":16718.48,"discounted_cash":4179.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"varicella-zoster i.glob-maltos 125 unit/1.2 mL solution 1.2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70504012602","type":"NDC"}],"standard_charges":[{"gross_charge":13142.65,"discounted_cash":3285.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"varicella-zoster i.glob-maltos 125 unit/1.2 mL solution 1.2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70504012601","type":"NDC"}],"standard_charges":[{"gross_charge":13142.65,"discounted_cash":3285.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxychlorosene sodium recon soln 2 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"250","type":"RC"},{"code":"327000110","type":"NDC"}],"standard_charges":[{"gross_charge":55.76,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cisatracurium 10 mg/mL conc. (ICU USE ONLY) solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021066920","type":"NDC"}],"standard_charges":[{"gross_charge":285.56,"discounted_cash":71.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution (del Nido) 26 mEq/1,052.8 mL (potassium) solution 1,052.8 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710-5138-","type":"NDC"}],"standard_charges":[{"gross_charge":80.64,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cardioplegic solution (del Nido) 26 mEq/1,052.8 mL (potassium) solution 1,052.8 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"72196020201","type":"NDC"}],"standard_charges":[{"gross_charge":80.64,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023021601","type":"NDC"}],"standard_charges":[{"gross_charge":37.41,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023021625","type":"NDC"}],"standard_charges":[{"gross_charge":37.41,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5%+Trophamine 3%+Ca Gluconate 0.0093 mEq/mL+HEParin PF 0.5 units/mL 3 %-5 %- 2.33 mEq/250 mL parenteral solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"72196042701","type":"NDC"}],"standard_charges":[{"gross_charge":386.83,"discounted_cash":96.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5%+Trophamine 3%+Ca Gluconate 0.0093 mEq/mL+HEParin PF 0.5 units/mL 3 %-5 %- 2.33 mEq/250 mL parenteral solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71285042701","type":"NDC"}],"standard_charges":[{"gross_charge":427.05,"discounted_cash":106.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fat emul-soy-mct-oliv-fish oiL 20 % emulsion 250 mL Bag","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323082004","type":"NDC"}],"standard_charges":[{"gross_charge":70.47,"discounted_cash":17.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021083601","type":"NDC"}],"standard_charges":[{"gross_charge":13.34,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70700024925","type":"NDC"}],"standard_charges":[{"gross_charge":28.37,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trace elements Zn-Cu-Mn-Se 3MG-0.3MG-55MCG-60MCG/ML solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"517930525","type":"NDC"}],"standard_charges":[{"gross_charge":189.23,"discounted_cash":47.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70700024922","type":"NDC"}],"standard_charges":[{"gross_charge":85.79,"discounted_cash":21.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70756061125","type":"NDC"}],"standard_charges":[{"gross_charge":30.92,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150037325","type":"NDC"}],"standard_charges":[{"gross_charge":32.62,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150037301","type":"NDC"}],"standard_charges":[{"gross_charge":32.62,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754420004","type":"NDC"}],"standard_charges":[{"gross_charge":111.65,"discounted_cash":27.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"51754420001","type":"NDC"}],"standard_charges":[{"gross_charge":111.65,"discounted_cash":27.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023021689","type":"NDC"}],"standard_charges":[{"gross_charge":85.53,"discounted_cash":21.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42023021683","type":"NDC"}],"standard_charges":[{"gross_charge":85.53,"discounted_cash":21.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ePHEDrine 50 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70756061182","type":"NDC"}],"standard_charges":[{"gross_charge":30.92,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hyaluronate 10 mg/mL syringe 0.85 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"50474063698","type":"NDC"}],"standard_charges":[{"gross_charge":1016.48,"discounted_cash":254.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trace elements Zn-Cu-Mn-Se 3MG-0.3MG-55MCG-60MCG/ML solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"517930501","type":"NDC"}],"standard_charges":[{"gross_charge":189.23,"discounted_cash":47.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitroprusside 25 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42998030202","type":"NDC"}],"standard_charges":[{"gross_charge":4643.03,"discounted_cash":1160.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"143938110","type":"NDC"}],"standard_charges":[{"gross_charge":171.31,"discounted_cash":42.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"143938101","type":"NDC"}],"standard_charges":[{"gross_charge":171.31,"discounted_cash":42.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323013002","type":"NDC"}],"standard_charges":[{"gross_charge":294.34,"discounted_cash":73.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68382091010","type":"NDC"}],"standard_charges":[{"gross_charge":59.64,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68382091001","type":"NDC"}],"standard_charges":[{"gross_charge":59.64,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323013017","type":"NDC"}],"standard_charges":[{"gross_charge":100.42,"discounted_cash":25.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457043700","type":"NDC"}],"standard_charges":[{"gross_charge":120.87,"discounted_cash":30.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323013011","type":"NDC"}],"standard_charges":[{"gross_charge":294.34,"discounted_cash":73.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antivenin Latrodectus mactans 6,000 unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"6542402","type":"NDC"}],"standard_charges":[{"gross_charge":212.26,"discounted_cash":53.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"4029809","type":"NDC"}],"standard_charges":[{"gross_charge":782.85,"discounted_cash":195.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose parenteral solution 2,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"990712007","type":"NDC"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":50.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose parenteral solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338071913","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose parenteral solution 2,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338071906","type":"NDC"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":50.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 40 % in water (D40W) 40 % parenteral solution 500 mL Flex Cont","drug_information":{"unit":0.0625,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409793719","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hypochlorite 0.5 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"39328006250","type":"NDC"}],"standard_charges":[{"gross_charge":112.32,"discounted_cash":28.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323013041","type":"NDC"}],"standard_charges":[{"gross_charge":100.42,"discounted_cash":25.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hypochlorite 0.5 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"436094616","type":"NDC"}],"standard_charges":[{"gross_charge":137.68,"discounted_cash":34.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288003020","type":"NDC"}],"standard_charges":[{"gross_charge":45.39,"discounted_cash":11.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"poractant alfa 120 mg/1.5 mL suspension 1.5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"10122051001","type":"NDC"}],"standard_charges":[{"gross_charge":4333.88,"discounted_cash":1083.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium hyaluronate 10 mg/mL syringe 0.85 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"8065183085","type":"NDC"}],"standard_charges":[{"gross_charge":261.44,"discounted_cash":65.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"201488200","type":"NDC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water parenteral solution 3,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338001308","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water parenteral solution 2,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338001306","type":"NDC"}],"standard_charges":[{"gross_charge":45.96,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338001304","type":"NDC"}],"standard_charges":[{"gross_charge":38.3,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water parenteral solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"264785010","type":"NDC"}],"standard_charges":[{"gross_charge":30.64,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric subsulfate 259 mg/g solution 8 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"250","type":"RC"},{"code":"59365606500","type":"NDC"}],"standard_charges":[{"gross_charge":117.35,"discounted_cash":29.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxercalciferoL 4 mcg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"J1270","type":"HCPCS"},{"code":"58468012301","type":"NDC"}],"standard_charges":[{"gross_charge":14.78,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gelatin adsorbable 100 sponge 6 each PF APPLI","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9034201","type":"NDC"}],"standard_charges":[{"gross_charge":341.93,"discounted_cash":85.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gelatin sponge,absorb-porcine 12-7 mm sponge 12 each PF APPLI","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9031508","type":"NDC"}],"standard_charges":[{"gross_charge":70.69,"discounted_cash":17.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gelatin absorbable powder 1 g Packet","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"250","type":"RC"},{"code":"9043304","type":"NDC"}],"standard_charges":[{"gross_charge":702.52,"discounted_cash":175.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Amino Acid 5%-Dextrose 20%-Electrolytes parenteral solution 2,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338703604","type":"NDC"}],"standard_charges":[{"gross_charge":536.2,"discounted_cash":134.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Amino Acid 5%-Dextrose 20%-Electrolytes parenteral solution 2,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338703601","type":"NDC"}],"standard_charges":[{"gross_charge":536.2,"discounted_cash":134.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Amino Acid 4.25%-Dextrose 10%-Electrolytes parenteral solution 2,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338702804","type":"NDC"}],"standard_charges":[{"gross_charge":428.96,"discounted_cash":107.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Amino Acid 4.25%-Dextrose 10%-Electrolytes parenteral solution 2,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338702801","type":"NDC"}],"standard_charges":[{"gross_charge":428.96,"discounted_cash":107.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxycycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288003021","type":"NDC"}],"standard_charges":[{"gross_charge":45.39,"discounted_cash":11.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproate 500 mg/5 mL solution 5 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323049405","type":"NDC"}],"standard_charges":[{"gross_charge":7.1,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproate 500 mg/5 mL solution 5 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021079705","type":"NDC"}],"standard_charges":[{"gross_charge":6.99,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproate 500 mg/5 mL solution 5 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70860078441","type":"NDC"}],"standard_charges":[{"gross_charge":22.69,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"olive,soybean oil fat emulsion 20 % emulsion 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338954006","type":"NDC"}],"standard_charges":[{"gross_charge":107.24,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"olive,soybean oil fat emulsion 20 % emulsion 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338954005","type":"NDC"}],"standard_charges":[{"gross_charge":103.41,"discounted_cash":25.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"olive,soybean oil fat emulsion 20 % emulsion 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338954002","type":"NDC"}],"standard_charges":[{"gross_charge":107.24,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"olive,soybean oil fat emulsion 20 % emulsion 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"338954001","type":"NDC"}],"standard_charges":[{"gross_charge":103.41,"discounted_cash":25.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metroNIDAZOLE in NaCl 500 mg/100 mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"97710500201","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 40 % in water (D40W) 40 % parenteral solution 500 mL Flex Cont","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409793719","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"barium sulfate 98 % suspension for reconstitution 1 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"32909076401","type":"NDC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":36.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitroprusside 25 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70436002880","type":"NDC"}],"standard_charges":[{"gross_charge":71.7,"discounted_cash":17.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitroprusside 25 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"71288020202","type":"NDC"}],"standard_charges":[{"gross_charge":128.46,"discounted_cash":32.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitroprusside 25 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70069026101","type":"NDC"}],"standard_charges":[{"gross_charge":91.69,"discounted_cash":22.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitroprusside 25 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457083902","type":"NDC"}],"standard_charges":[{"gross_charge":629.81,"discounted_cash":157.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitroprusside 25 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"42571026575","type":"NDC"}],"standard_charges":[{"gross_charge":230.72,"discounted_cash":57.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitroprusside 25 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"14789001202","type":"NDC"}],"standard_charges":[{"gross_charge":849.34,"discounted_cash":212.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitroprusside 25 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021031002","type":"NDC"}],"standard_charges":[{"gross_charge":995.72,"discounted_cash":248.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium nitroprusside 25 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"187430202","type":"NDC"}],"standard_charges":[{"gross_charge":6359.56,"discounted_cash":1589.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"409669502","type":"NDC"}],"standard_charges":[{"gross_charge":46.11,"discounted_cash":11.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"25021067420","type":"NDC"}],"standard_charges":[{"gross_charge":22.83,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143950601","type":"NDC"}],"standard_charges":[{"gross_charge":36.39,"discounted_cash":9.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143950610","type":"NDC"}],"standard_charges":[{"gross_charge":36.39,"discounted_cash":9.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproate 500 mg/5 mL solution 5 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"70860078405","type":"NDC"}],"standard_charges":[{"gross_charge":22.69,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproate 500 mg/5 mL solution 5 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323049441","type":"NDC"}],"standard_charges":[{"gross_charge":6.99,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproate 500 mg/5 mL solution 5 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323049401","type":"NDC"}],"standard_charges":[{"gross_charge":7.1,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproate 500 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"63323049416","type":"NDC"}],"standard_charges":[{"gross_charge":13.98,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproate 500 mg/5 mL solution 5 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143978501","type":"NDC"}],"standard_charges":[{"gross_charge":80.77,"discounted_cash":20.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"72572016010","type":"NDC"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"72572016001","type":"NDC"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"citrate dextrose solution solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"942064104","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219044720","type":"NDC"}],"standard_charges":[{"gross_charge":25.43,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"72266014710","type":"NDC"}],"standard_charges":[{"gross_charge":28.19,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"72266014701","type":"NDC"}],"standard_charges":[{"gross_charge":28.19,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457090320","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"67457090300","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150022220","type":"NDC"}],"standard_charges":[{"gross_charge":38.3,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"55150022110","type":"NDC"}],"standard_charges":[{"gross_charge":29.34,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"143950701","type":"NDC"}],"standard_charges":[{"gross_charge":51.48,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etomidate 2 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"250","type":"RC"},{"code":"65219044702","type":"NDC"}],"standard_charges":[{"gross_charge":25.43,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687063365","type":"NDC"}],"standard_charges":[{"gross_charge":10.02,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitrofurantoin (macrocrystal-monohydrate) 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756040411","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norethindrone ac-eth estradioL 1-20 mg-mcg tablet 21 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555902542","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904730861","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904630361","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462016501","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382009501","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079093201","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 6.25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904730661","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 6.25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904630161","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 6.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547025510","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 6.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462016301","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 6.25 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382009305","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 6.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382009301","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 6.25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079093001","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 6.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93013501","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bicalutamide 50 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335048583","type":"NDC"}],"standard_charges":[{"gross_charge":2.61,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bicalutamide 50 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729002310","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 100 mg/5 mL suspension for reconstitution 15 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93202723","type":"NDC"}],"standard_charges":[{"gross_charge":48.7,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bicalutamide 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729002301","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 100 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201305","type":"NDC"}],"standard_charges":[{"gross_charge":21.95,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 100 mg/5 mL suspension for reconstitution 15 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70710145701","type":"NDC"}],"standard_charges":[{"gross_charge":82.15,"discounted_cash":20.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamiVUDine 10 mg/mL solution 240 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862005524","type":"NDC"}],"standard_charges":[{"gross_charge":384.23,"discounted_cash":96.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamiVUDine 10 mg/mL solution 240 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"57237027424","type":"NDC"}],"standard_charges":[{"gross_charge":569.9,"discounted_cash":142.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamiVUDine 10 mg/mL solution 1 mL Syringe","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710204501","type":"NDC"}],"standard_charges":[{"gross_charge":3.32,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamiVUDine 10 mg/mL solution 240 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"49702020548","type":"NDC"}],"standard_charges":[{"gross_charge":827.28,"discounted_cash":206.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamiVUDine 150 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702020318","type":"NDC"}],"standard_charges":[{"gross_charge":51.75,"discounted_cash":12.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 200 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710215005","type":"NDC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 200 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710214105","type":"NDC"}],"standard_charges":[{"gross_charge":35.95,"discounted_cash":8.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 200 mg/5 mL suspension for reconstitution 15 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70710145802","type":"NDC"}],"standard_charges":[{"gross_charge":82.15,"discounted_cash":20.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 200 mg/5 mL suspension for reconstitution 15 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42806014932","type":"NDC"}],"standard_charges":[{"gross_charge":34.34,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 200 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201605","type":"NDC"}],"standard_charges":[{"gross_charge":19.38,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 200 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201505","type":"NDC"}],"standard_charges":[{"gross_charge":33.33,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 200 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201405","type":"NDC"}],"standard_charges":[{"gross_charge":13.17,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 200 mg/5 mL suspension for reconstitution 15 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93202623","type":"NDC"}],"standard_charges":[{"gross_charge":48.7,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 100 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710214805","type":"NDC"}],"standard_charges":[{"gross_charge":13.59,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 100 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710214205","type":"NDC"}],"standard_charges":[{"gross_charge":35.95,"discounted_cash":8.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin 100 mg/5 mL suspension for reconstitution 15 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42806014731","type":"NDC"}],"standard_charges":[{"gross_charge":41.45,"discounted_cash":10.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamiVUDine 10 mg/mL solution 1 mL Syringe","drug_information":{"unit":0.00417,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710212601","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitonin 200 unit/actuation spray,non-aerosol 3.7 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"49884016111","type":"NDC"}],"standard_charges":[{"gross_charge":167.04,"discounted_cash":41.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan 25 MG tablet 27 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111029198","type":"NDC"}],"standard_charges":[{"gross_charge":7.92,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan 25 MG tablet 9 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862014636","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan 25 MG tablet 9 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756052069","type":"NDC"}],"standard_charges":[{"gross_charge":2.7,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111029109","type":"NDC"}],"standard_charges":[{"gross_charge":7.92,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"60687088511","type":"NDC"}],"standard_charges":[{"gross_charge":3.12,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"72888019201","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"50268055711","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"904707461","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"60687049411","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"60687049401","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"68084079511","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"68084079501","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"67877026601","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"51079072101","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"16729009401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 5,000 unit capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53191024401","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitonin 200 unit/actuation spray,non-aerosol 3.7 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"gross_charge":205.63,"discounted_cash":51.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 5,000 unit capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268086811","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alendronate 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980034001","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"81033001751","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"81033001730","type":"NDC"}],"standard_charges":[{"gross_charge":8.38,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687083445","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50268018330","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 30 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50268018311","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium citrate-citric acid 500-334 mg/5 mL solution 473 mL Bottle","drug_information":{"unit":0.03171,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121059516","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alendronate 10 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980034003","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 5,000 unit capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268086815","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tretinoin 10 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370026801","type":"NDC"}],"standard_charges":[{"gross_charge":79.8,"discounted_cash":19.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tretinoin 10 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084007511","type":"NDC"}],"standard_charges":[{"gross_charge":132.23,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isopropyl alcohoL 70 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000049701","type":"NDC"}],"standard_charges":[{"gross_charge":14.49,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desvenlafaxine succinate 25 mg tablet extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591406030","type":"NDC"}],"standard_charges":[{"gross_charge":5.77,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isavuconazonium sulfate 186 mg capsule 14 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"469052014","type":"NDC"}],"standard_charges":[{"gross_charge":394.54,"discounted_cash":98.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisdexamfetamine 10 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505473901","type":"NDC"}],"standard_charges":[{"gross_charge":26.04,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisdexamfetamine 10 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"527466137","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisdexamfetamine 10 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417010110","type":"NDC"}],"standard_charges":[{"gross_charge":51.39,"discounted_cash":12.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liraglutide (weight loss) 3 mg/0.5 mL (18 mg/3 mL) pen injector 3 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"169280015","type":"NDC"}],"standard_charges":[{"gross_charge":1072.55,"discounted_cash":268.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROcodone bitartrate 80 mg tablet,oral only,ext.rel.24 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011027560","type":"NDC"}],"standard_charges":[{"gross_charge":186.93,"discounted_cash":46.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ritonavir 80 mg/mL solution 240 mL Bottle","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"74194063","type":"NDC"}],"standard_charges":[{"gross_charge":98.3,"discounted_cash":24.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 80 mg tablet,oral only,ext.rel.12 hr 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011048020","type":"NDC"}],"standard_charges":[{"gross_charge":129.75,"discounted_cash":32.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 80 mg tablet,oral only,ext.rel.12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011048010","type":"NDC"}],"standard_charges":[{"gross_charge":126.52,"discounted_cash":31.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 40 mg tablet,oral only,ext.rel.12 hr 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011044020","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 40 mg tablet,oral only,ext.rel.12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011044010","type":"NDC"}],"standard_charges":[{"gross_charge":72.93,"discounted_cash":18.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 30 mg tablet,oral only,ext.rel.12 hr 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011043020","type":"NDC"}],"standard_charges":[{"gross_charge":60.93,"discounted_cash":15.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg tablet,oral only,ext.rel.12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93573201","type":"NDC"}],"standard_charges":[{"gross_charge":18.63,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg tablet,oral only,ext.rel.12 hr 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"gross_charge":44.08,"discounted_cash":11.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832030100","type":"NDC"}],"standard_charges":[{"gross_charge":7.67,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg tablet,oral only,ext.rel.12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043011","type":"NDC"}],"standard_charges":[{"gross_charge":6.9,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268016311","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARoxetine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904567661","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARoxetine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739088810","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARoxetine 10 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378700193","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARoxetine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084004411","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorthalidone 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079005801","type":"NDC"}],"standard_charges":[{"gross_charge":9.29,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorthalidone 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904690061","type":"NDC"}],"standard_charges":[{"gross_charge":8.03,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorthalidone 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598071901","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorthalidone 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378022201","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079051901","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":4.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043065","type":"NDC"}],"standard_charges":[{"gross_charge":6.9,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904713006","type":"NDC"}],"standard_charges":[{"gross_charge":9.37,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832601800","type":"NDC"}],"standard_charges":[{"gross_charge":3.95,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904713061","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304014301","type":"NDC"}],"standard_charges":[{"gross_charge":15.76,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268016315","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904689361","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 15 mg tablet,oral only,ext.rel.12 hr 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011041520","type":"NDC"}],"standard_charges":[{"gross_charge":35.02,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 15 mg tablet,oral only,ext.rel.12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011041510","type":"NDC"}],"standard_charges":[{"gross_charge":34.15,"discounted_cash":8.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 10 mg tablet,oral only,ext.rel.12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93573101","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ivabradine 5 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332067960","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ivabradine 5 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742036260","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ivabradine 5 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513080060","type":"NDC"}],"standard_charges":[{"gross_charge":42.47,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE-zinc acetate 2-0.1 % cream 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904535431","type":"NDC"}],"standard_charges":[{"gross_charge":7.53,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlordiazePOXIDE 25 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079014101","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlordiazePOXIDE 25 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135022260","type":"NDC"}],"standard_charges":[{"gross_charge":69.19,"discounted_cash":17.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlordiazePOXIDE 25 MG capsule 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555015904","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlordiazePOXIDE 25 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555015902","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlordiazePOXIDE 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079037501","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlordiazePOXIDE 10 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555003302","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitRIOL 1 mcg/mL solution 15 mL Bottle","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54312041","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"anastrozole 1 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651023630","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"anastrozole 1 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729003510","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin 0.1 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084060621","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin 0.1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084060611","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tiotropium bromide 2.5 mcg/actuation mist 4 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"597010051","type":"NDC"}],"standard_charges":[{"gross_charge":149.07,"discounted_cash":37.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"raltegravir 100 mg powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6360301","type":"NDC"}],"standard_charges":[{"gross_charge":35.54,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droxidopa 100 mg capsule 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67386082019","type":"NDC"}],"standard_charges":[{"gross_charge":79.42,"discounted_cash":19.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atazanavir 50 mg powder in packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3363810","type":"NDC"}],"standard_charges":[{"gross_charge":29.44,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 10 mg tablet,oral only,ext.rel.12 hr 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"gross_charge":24.13,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 10 mg tablet,oral only,ext.rel.12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011041010","type":"NDC"}],"standard_charges":[{"gross_charge":23.52,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuteroL 20-100 mcg/actuation mist 4 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"597002402","type":"NDC"}],"standard_charges":[{"gross_charge":1703.1,"discounted_cash":425.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"empagliflozin 10 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"597015237","type":"NDC"}],"standard_charges":[{"gross_charge":66.31,"discounted_cash":16.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"empagliflozin 10 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"597015230","type":"NDC"}],"standard_charges":[{"gross_charge":66.31,"discounted_cash":16.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"empagliflozin 25 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"597015337","type":"NDC"}],"standard_charges":[{"gross_charge":66.31,"discounted_cash":16.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chloroquine 250 mg tablet 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980017750","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone 750 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"81033010422","type":"NDC"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":18.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glimepiride 4 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268036015","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glimepiride 4 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729000301","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glimepiride 4 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079042601","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glimepiride 4 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111032201","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glimepiride 2 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268035915","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glimepiride 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268035911","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glimepiride 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084032611","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glimepiride 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079042501","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glimepiride 4 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268036011","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone 750 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710221705","type":"NDC"}],"standard_charges":[{"gross_charge":26.17,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone 750 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"81033010405","type":"NDC"}],"standard_charges":[{"gross_charge":75.6,"discounted_cash":18.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone 750 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687053436","type":"NDC"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":17.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904700761","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739067010","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084031811","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672413001","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carisoprodoL 350 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584011110","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carisoprodoL 350 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742065601","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carisoprodoL 350 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228010901","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carisoprodoL 350 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61442045101","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carisoprodoL 350 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756044602","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc 500 unit/gram ointment 14 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"61269010534","type":"NDC"}],"standard_charges":[{"gross_charge":14.52,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc 500 unit/gram ointment 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536126328","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc 500 unit/gram ointment 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"14428000944","type":"NDC"}],"standard_charges":[{"gross_charge":13.76,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc 500 unit/gram ointment 14 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"14428000888","type":"NDC"}],"standard_charges":[{"gross_charge":11.52,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc 500 unit/gram ointment 14.2 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672207501","type":"NDC"}],"standard_charges":[{"gross_charge":7.04,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole nitrate 2 % ointment 57 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"11701006723","type":"NDC"}],"standard_charges":[{"gross_charge":33.99,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079049901","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904754361","type":"NDC"}],"standard_charges":[{"gross_charge":3.82,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862022801","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739051610","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 1 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904612661","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 1 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746038306","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dorzolamide 2 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"72266019701","type":"NDC"}],"standard_charges":[{"gross_charge":180.55,"discounted_cash":45.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dorzolamide 2 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314001910","type":"NDC"}],"standard_charges":[{"gross_charge":117.96,"discounted_cash":29.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dorzolamide 2 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383023210","type":"NDC"}],"standard_charges":[{"gross_charge":75.07,"discounted_cash":18.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone-aloe vera 1 % cream 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"61269033956","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone-aloe vera 1 % cream 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904762331","type":"NDC"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-30 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079016120","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-30 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406048423","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-30 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603233821","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-30 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084037201","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-30 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406048462","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-30 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406048401","type":"NDC"}],"standard_charges":[{"gross_charge":2.7,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904700861","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739017910","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lamoTRIgine 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084031911","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687065311","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687065301","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904693061","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 100 mg tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672404101","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 100 mg tablet,chewable 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079087001","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 100 mg tablet,chewable 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904385461","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nefazodone 100 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93102406","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"saliva substitute combo no.9 mouthwash 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"48582004566","type":"NDC"}],"standard_charges":[{"gross_charge":25.83,"discounted_cash":6.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 600 mg tablet extended release 12hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094004861","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 600 mg tablet extended release 12hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094004859","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 600 mg tablet extended release 12hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904671839","type":"NDC"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 600 mg tablet extended release 12hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536116361","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 600 mg tablet extended release 12hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084057211","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin 600 mg tablet extended release 12hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824000815","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 mg/mL syringe 1 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856100201","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 mg/mL syringe 1 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856006305","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 mg/mL syringe 1 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856067401","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 mg/mL syringe 1 mL Syringe","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710206801","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 200 mg/10 mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121189494","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 200 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904617261","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 200 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084044401","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 200 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084044411","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304009001","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268067113","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268067111","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180079901","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746054201","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574018101","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride 10 MEQ capsule, extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62037056001","type":"NDC"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 1 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268076411","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbamide peroxide 6.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904747835","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbamide peroxide 6.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904662735","type":"NDC"}],"standard_charges":[{"gross_charge":7.06,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbamide peroxide 6.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"78112073623","type":"NDC"}],"standard_charges":[{"gross_charge":21.23,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbamide peroxide 6.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42037010478","type":"NDC"}],"standard_charges":[{"gross_charge":26.84,"discounted_cash":6.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 200 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505018300","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 200 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079038520","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 200 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079038501","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carBAMazepine 200 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834022101","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbamide peroxide 6.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000049001","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone furoate-vilanteroL 200-25 mcg/dose blister with device 28 each BLIST PACK","drug_information":{"unit":28.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"173088214","type":"NDC"}],"standard_charges":[{"gross_charge":399.13,"discounted_cash":99.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 1 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268076415","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 1 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079093601","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084034711","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862020299","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862020290","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862020230","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93736598","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6095231","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":3.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704761","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 25 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268050415","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268050411","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739067310","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084034611","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 25 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862020190","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tiZANidine 4 MG tablet 150 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664050389","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tiZANidine 4 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084064565","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tiZANidine 4 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084064511","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382013606","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 850 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904716361","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332002830","type":"NDC"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268050511","type":"NDC"}],"standard_charges":[{"gross_charge":2.03,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone 750 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687053440","type":"NDC"}],"standard_charges":[{"gross_charge":70.16,"discounted_cash":17.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone 750 mg/5 mL suspension 5 mL Packet","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68462042169","type":"NDC"}],"standard_charges":[{"gross_charge":62.6,"discounted_cash":15.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone 750 mg/5 mL suspension 210 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"31722062921","type":"NDC"}],"standard_charges":[{"gross_charge":1098.97,"discounted_cash":274.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone 750 mg/5 mL suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689006201","type":"NDC"}],"standard_charges":[{"gross_charge":134.86,"discounted_cash":33.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atovaquone 750 mg/5 mL suspension 5 mL BLIST PACK","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"173054700","type":"NDC"}],"standard_charges":[{"gross_charge":130.49,"discounted_cash":32.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxylamine 25 mg tablet 48 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000056701","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxylamine 25 mg tablet 32 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167000609","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosfomycin 3 gram packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877074957","type":"NDC"}],"standard_charges":[{"gross_charge":259.22,"discounted_cash":64.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosfomycin 3 gram packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82036427408","type":"NDC"}],"standard_charges":[{"gross_charge":307.4,"discounted_cash":76.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosfomycin 3 gram packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82036427401","type":"NDC"}],"standard_charges":[{"gross_charge":307.4,"discounted_cash":76.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosfomycin 3 gram packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70700026899","type":"NDC"}],"standard_charges":[{"gross_charge":273.5,"discounted_cash":68.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosfomycin 3 gram packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70700026894","type":"NDC"}],"standard_charges":[{"gross_charge":273.5,"discounted_cash":68.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosfomycin 3 gram packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456430001","type":"NDC"}],"standard_charges":[{"gross_charge":356.75,"discounted_cash":89.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosfomycin 3 gram packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456430008","type":"NDC"}],"standard_charges":[{"gross_charge":356.75,"discounted_cash":89.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904704861","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"losartan 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739068610","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 850 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904669061","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 850 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687014311","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 850 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687014301","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 180 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079089901","type":"NDC"}],"standard_charges":[{"gross_charge":7.42,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 180 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050411","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 180 MG tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050401","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 180 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834015801","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 180 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462029301","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 5 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079093801","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 5 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155073701","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 5 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268076615","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 5 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268076611","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 5 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746038506","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 2 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079093701","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 2 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155073601","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 2 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268076515","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 2 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268076511","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 2 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746038406","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin SR 75 mg capsule, extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084041111","type":"NDC"}],"standard_charges":[{"gross_charge":16.86,"discounted_cash":4.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin SR 75 mg capsule, extended release 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084041121","type":"NDC"}],"standard_charges":[{"gross_charge":16.86,"discounted_cash":4.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin SR 75 mg capsule, extended release 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722056560","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indomethacin SR 75 mg capsule, extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268043211","type":"NDC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metFORMIN 850 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155010301","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93005805","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93005801","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664037708","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904749661","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687079511","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687079501","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terazosin 1 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155073501","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219234801","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888008001","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55154254107","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084080811","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084080801","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904636561","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162062710","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079099101","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traMADoL 50 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904717961","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 24-26 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78065920","type":"NDC"}],"standard_charges":[{"gross_charge":47.73,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 24-26 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78065935","type":"NDC"}],"standard_charges":[{"gross_charge":28.66,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 24-26 mg tablet 180 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78065967","type":"NDC"}],"standard_charges":[{"gross_charge":47.73,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 150 MG tablet sustained-release 12 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084070895","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 150 MG tablet sustained-release 12 hr 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084070825","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 100 MG tablet sustained-release 12 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904727061","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 100 MG tablet sustained-release 12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436005801","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 100 MG tablet sustained-release 12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547028810","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 100 MG tablet sustained-release 12 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084069711","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 100 MG tablet sustained-release 12 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084069701","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904736261","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904635961","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382011414","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084027211","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079046201","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458059210","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil, light sterile oil 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323025410","type":"NDC"}],"standard_charges":[{"gross_charge":37.72,"discounted_cash":9.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 150 MG tablet sustained-release 12 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904658561","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil, light sterile oil 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323025402","type":"NDC"}],"standard_charges":[{"gross_charge":33.23,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 150 MG tablet sustained-release 12 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598075260","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 150 MG tablet sustained-release 12 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904721461","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"latanoprost 0.005 % drops 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208046325","type":"NDC"}],"standard_charges":[{"gross_charge":71.82,"discounted_cash":17.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"96295013836","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555002700","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904053961","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904053061","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904053060","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopent-tropic-phen-ketr-wat 1 %-1 %-10 %- 0.5 % drops 1 each Syringe","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71266824101","type":"NDC"}],"standard_charges":[{"gross_charge":66.78,"discounted_cash":16.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 3.125 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904730561","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 3.125 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084084311","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 3.125 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904630061","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 3.125 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547025410","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 3.125 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382009201","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carvedilol 3.125 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079077101","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pedi mv no.189-ferrous sulfate 11 mg iron/mL drops 50 mL DROP BTL","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"87040501","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 150 MG tablet sustained-release 12 hr 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904746561","type":"NDC"}],"standard_charges":[{"gross_charge":4.43,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion SR 150 MG tablet sustained-release 12 hr 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228017501","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 3 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904736461","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 3 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904636161","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904736361","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084076211","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877022305","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877022301","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505011300","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756013802","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904563261","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 400 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739090410","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 400 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687060211","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 400 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904666761","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 400 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739098410","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 400 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084077411","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 400 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877022401","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 400 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505011400","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 400 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756013902","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 400 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904563361","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483060601","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739023610","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904666661","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059101","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904636061","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 2 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382011514","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079046301","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739090210","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687058011","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687058001","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904666561","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"latanoprost 0.005 % drops 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"59762033302","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739059110","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084078311","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877022201","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722022101","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505011200","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505011201","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739090310","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 300 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059111","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097081307","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"torsemide 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268075515","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"latanoprost 0.005 % drops 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"gross_charge":25.28,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"latanoprost 0.005 % drops 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478062512","type":"NDC"}],"standard_charges":[{"gross_charge":75.1,"discounted_cash":18.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cabergoline 0.5 mg tablet 8 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742011808","type":"NDC"}],"standard_charges":[{"gross_charge":13.23,"discounted_cash":3.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cabergoline 0.5 mg tablet 8 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93542088","type":"NDC"}],"standard_charges":[{"gross_charge":38.06,"discounted_cash":9.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oil cream 113 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"80681015500","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oil cream 113 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"72140000022","type":"NDC"}],"standard_charges":[{"gross_charge":21.36,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079020901","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 20 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378395177","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084009811","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904629161","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 40 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904629206","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 40 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877051390","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 40 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097094605","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079020801","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084009711","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atorvastatin 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904629061","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nirmatrelvir-ritonavir 150 mg (10)- 100 mg (10) tablets,dose pack 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69110120","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cabergoline 0.5 mg tablet 8 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155082373","type":"NDC"}],"standard_charges":[{"gross_charge":8.93,"discounted_cash":2.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056815","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproic acid 250 mg/5 mL (5 mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121467505","type":"NDC"}],"standard_charges":[{"gross_charge":5.78,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproic acid 250 mg/5 mL (5 mL) solution 10 mL Cup","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121135010","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"betaxoloL 0.25 % drops,suspension 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65024610","type":"NDC"}],"standard_charges":[{"gross_charge":1213.84,"discounted_cash":303.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"betaxoloL 0.25 % drops,suspension 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"78072910","type":"NDC"}],"standard_charges":[{"gross_charge":1612.51,"discounted_cash":403.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 10 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"75907013023","type":"NDC"}],"standard_charges":[{"gross_charge":102.73,"discounted_cash":25.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 10 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70756061430","type":"NDC"}],"standard_charges":[{"gross_charge":99.54,"discounted_cash":24.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 10 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478020605","type":"NDC"}],"standard_charges":[{"gross_charge":140.7,"discounted_cash":35.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine 10 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42702010305","type":"NDC"}],"standard_charges":[{"gross_charge":156.58,"discounted_cash":39.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-15 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93005001","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-15 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603233721","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 6 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93171801","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 6 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162076710","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 6 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56018901","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 3 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93171501","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 3 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121489","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 3 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56018801","type":"NDC"}],"standard_charges":[{"gross_charge":9.69,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 3 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121401","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproic acid 250 mg/5 mL (5 mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094019359","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mupirocin 2 % ointment 1 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"50268056811","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nirmatrelvir-ritonavir 150 mg - 100 mg tablets,dose pack 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69108530","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nirmatrelvir-ritonavir 150 mg - 100 mg tablets,dose pack 6 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69108506","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"donepeziL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904647761","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"donepeziL 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739064610","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"donepeziL 5 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547027509","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorescein-benoxinate 0.3-0.4 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"82260073405","type":"NDC"}],"standard_charges":[{"gross_charge":135.74,"discounted_cash":33.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 2.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710221102","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 2.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217402","type":"NDC"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketamine 10 mg/mL solution 2.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216802","type":"NDC"}],"standard_charges":[{"gross_charge":12.66,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin 250 mcg-50 mg- 10 mcg/mL syringe 50 mL DROP BTL","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"87040203","type":"NDC"}],"standard_charges":[{"gross_charge":0.45,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin 250 mcg-50 mg- 10 mcg/mL syringe 1 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856023002","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin 250 mcg-50 mg- 10 mcg/mL syringe 1 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856040203","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin 250 mcg-50 mg- 10 mcg/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856040202","type":"NDC"}],"standard_charges":[{"gross_charge":6.62,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin 250 mcg-50 mg- 10 mcg/mL syringe 1 mL Syringe","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710211401","type":"NDC"}],"standard_charges":[{"gross_charge":0.43,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 40 % gel 3 mL Syringe","drug_information":{"unit":0.66667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54758000628","type":"NDC"}],"standard_charges":[{"gross_charge":18.23,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"latanoprost 0.005 % drops 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70069042101","type":"NDC"}],"standard_charges":[{"gross_charge":18.23,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"donepeziL 10 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547027603","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"donepeziL 10 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547027609","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"donepeziL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739067810","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"donepeziL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904647861","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904692961","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 100 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382014014","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084034411","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 200 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382014114","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 200 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084034511","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904692861","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084034211","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"latanoprost 0.005 % drops 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314054703","type":"NDC"}],"standard_charges":[{"gross_charge":64.02,"discounted_cash":16.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topiramate 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084034201","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levoFLOXacin 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084048211","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levoFLOXacin 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904635161","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 4 mg/5 mL solution 2.5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710223602","type":"NDC"}],"standard_charges":[{"gross_charge":4.33,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 4 mg/5 mL solution 2.5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710223202","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 4 mg/5 mL solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65162069179","type":"NDC"}],"standard_charges":[{"gross_charge":51.24,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 4 mg/5 mL solution 50 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54006447","type":"NDC"}],"standard_charges":[{"gross_charge":86.52,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL-zinc chlor 20-0.26-0.15 % gel 7 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"10310028340","type":"NDC"}],"standard_charges":[{"gross_charge":25.9,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levoFLOXacin 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904635261","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 mg/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856067301","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"torsemide 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268075511","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"torsemide 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111091601","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin 150 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292001820","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin 150 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292001801","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin 150 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904595961","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin 150 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084024311","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE 1 mg/mL solution 30 mL Bottle","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65162067384","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 400 mg capsule (with del rel tablets) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055633","type":"NDC"}],"standard_charges":[{"gross_charge":25.78,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 400 mg capsule (with del rel tablets) 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055632","type":"NDC"}],"standard_charges":[{"gross_charge":25.78,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 400 mg capsule (with del rel tablets) 180 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93590786","type":"NDC"}],"standard_charges":[{"gross_charge":9.49,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 400 mg capsule (with del rel tablets) 180 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762011701","type":"NDC"}],"standard_charges":[{"gross_charge":15.41,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesalamine 400 mg capsule (with del rel tablets) 180 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23585318","type":"NDC"}],"standard_charges":[{"gross_charge":16.19,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venetoclax 100 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"74057611","type":"NDC"}],"standard_charges":[{"gross_charge":562.16,"discounted_cash":140.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cariprazine 1.5 mg capsule 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61874011520","type":"NDC"}],"standard_charges":[{"gross_charge":201.17,"discounted_cash":50.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cariprazine 1.5 mg capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61874011511","type":"NDC"}],"standard_charges":[{"gross_charge":201.17,"discounted_cash":50.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"xylitol 550 mg muco-adhesive buccal tablet 40 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55933000051","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"xylitol 550 mg muco-adhesive buccal tablet 40 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55933000020","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin 150 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304069201","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium zirconium cyclosilicate 10 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"310111001","type":"NDC"}],"standard_charges":[{"gross_charge":90.19,"discounted_cash":22.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylnaltrexone 150 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649015090","type":"NDC"}],"standard_charges":[{"gross_charge":112.48,"discounted_cash":28.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium polystyrene 15-20 gram/60 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"46287000601","type":"NDC"}],"standard_charges":[{"gross_charge":882.05,"discounted_cash":220.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mirtazapine 15 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107003134","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mirtazapine 15 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505024701","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mirtazapine 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084011911","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mirtazapine 15 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079008601","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mirtazapine 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084011901","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % adhesive patch,medicated 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536120207","type":"NDC"}],"standard_charges":[{"gross_charge":3.89,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % adhesive patch,medicated 6 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000055701","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % adhesive patch,medicated 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000036601","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % adhesive patch,medicated 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536120215","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % adhesive patch,medicated 6 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46581083006","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % adhesive patch,medicated 6 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45611000938","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % adhesive patch,medicated 3 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45611000936","type":"NDC"}],"standard_charges":[{"gross_charge":14.21,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 4 % adhesive patch,medicated 5 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167005840","type":"NDC"}],"standard_charges":[{"gross_charge":7.94,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium polystyrene 15-20 gram/60 mL suspension 60 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"gross_charge":104.08,"discounted_cash":26.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium polystyrene 15-20 gram/60 mL suspension 60 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213609","type":"NDC"}],"standard_charges":[{"gross_charge":77.11,"discounted_cash":19.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium zirconium cyclosilicate 5 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"310110501","type":"NDC"}],"standard_charges":[{"gross_charge":90.19,"discounted_cash":22.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyoscyamine 0.125 mg tablet, sublingual 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559042401","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyoscyamine 0.125 mg tablet, sublingual 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781001101","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 3 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094011059","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 3 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094011061","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 3 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333051625","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 3 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333051610","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 3 mg tablet 240 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31604002742","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323018510","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"water for injection, sterile solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"409488710","type":"NDC"}],"standard_charges":[{"gross_charge":9.42,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 97-103 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205028260","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 97-103 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78069620","type":"NDC"}],"standard_charges":[{"gross_charge":47.73,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 49-51 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205028160","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 49-51 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598064460","type":"NDC"}],"standard_charges":[{"gross_charge":6.96,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 49-51 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78077720","type":"NDC"}],"standard_charges":[{"gross_charge":47.73,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 24-26 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205028060","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 24-26 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598064360","type":"NDC"}],"standard_charges":[{"gross_charge":5.38,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sacubitriL-valsartan 24-26 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78065961","type":"NDC"}],"standard_charges":[{"gross_charge":28.66,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 3 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10006070031","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 3 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681008500","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 3 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555003601","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 3 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555003600","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyoscyamine 0.125 mg tablet, sublingual 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76439030910","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyoscyamine 0.125 mg tablet, sublingual 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43199001101","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone 4 mg/actuation spray,non-aerosol 2 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69547062702","type":"NDC"}],"standard_charges":[{"gross_charge":94.5,"discounted_cash":23.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone 4 mg/actuation spray,non-aerosol 2 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802057884","type":"NDC"}],"standard_charges":[{"gross_charge":118.06,"discounted_cash":29.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone 4 mg/actuation spray,non-aerosol 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802057800","type":"NDC"}],"standard_charges":[{"gross_charge":118.06,"discounted_cash":29.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone 4 mg/actuation spray,non-aerosol 2 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802081184","type":"NDC"}],"standard_charges":[{"gross_charge":146.37,"discounted_cash":36.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone 4 mg/actuation spray,non-aerosol 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802081100","type":"NDC"}],"standard_charges":[{"gross_charge":146.37,"discounted_cash":36.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mirtazapine 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904651961","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone 4 mg/actuation spray,non-aerosol 2 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781717612","type":"NDC"}],"standard_charges":[{"gross_charge":128.84,"discounted_cash":32.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"compound vehicle susp SF no.20 (Ora-Plus) suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574030316","type":"NDC"}],"standard_charges":[{"gross_charge":85.42,"discounted_cash":21.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"elviteg-cob-emtri-tenof ALAFEN 150-150-200-10 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958190101","type":"NDC"}],"standard_charges":[{"gross_charge":575.5,"discounted_cash":143.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"patiromer calcium sorbitex 8.4 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53436008401","type":"NDC"}],"standard_charges":[{"gross_charge":103.03,"discounted_cash":25.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"patiromer calcium sorbitex 8.4 gram powder in packet 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53436008430","type":"NDC"}],"standard_charges":[{"gross_charge":103.03,"discounted_cash":25.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mulivitamin with minerals liquid 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710218207","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mulivitamin with minerals liquid 237 mL Bottle","drug_information":{"unit":0.06329,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"79854008009","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mulivitamin with minerals liquid 237 mL Bottle","drug_information":{"unit":0.06329,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54629080098","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone 4 mg/actuation spray,non-aerosol 2 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69547035302","type":"NDC"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":61.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"torsemide 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722053001","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mirtazapine 15 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378351501","type":"NDC"}],"standard_charges":[{"gross_charge":2.03,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clomiPRAMINE 50 MG capsule 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672401206","type":"NDC"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904637661","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505311300","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904637761","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598016430","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505311100","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93576801","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lipase-protease-amylase (pork) 5,000-17,000- 24,000 unit capsule,delayed release(DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"73562011501","type":"NDC"}],"standard_charges":[{"gross_charge":9.46,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lipase-protease-amylase (pork) 5,000-17,000- 24,000 unit capsule,delayed release(DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23611501","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylphenidate HCl ER 72 mg tablet extended release 24hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13811071030","type":"NDC"}],"standard_charges":[{"gross_charge":76.73,"discounted_cash":19.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"brimonidine 0.2 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314014310","type":"NDC"}],"standard_charges":[{"gross_charge":47.42,"discounted_cash":11.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"brimonidine 0.2 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314014305","type":"NDC"}],"standard_charges":[{"gross_charge":27.89,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"brimonidine 0.2 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208041110","type":"NDC"}],"standard_charges":[{"gross_charge":108.74,"discounted_cash":27.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"brimonidine 0.2 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208041105","type":"NDC"}],"standard_charges":[{"gross_charge":57.88,"discounted_cash":14.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"brimonidine 0.2 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"gross_charge":12.14,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"brimonidine 0.2 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478071512","type":"NDC"}],"standard_charges":[{"gross_charge":21.48,"discounted_cash":5.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"balsam peru-castor oiL ointment 56.7 g Tube","drug_information":{"unit":1.0582,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"58980078021","type":"NDC"}],"standard_charges":[{"gross_charge":94.75,"discounted_cash":23.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"brimonidine 0.2 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478071510","type":"NDC"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"balsam peru-castor oiL ointment 60 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"71351001460","type":"NDC"}],"standard_charges":[{"gross_charge":68.04,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"codeine 30 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54024425","type":"NDC"}],"standard_charges":[{"gross_charge":4.01,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisoprolol 5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954045510","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687072721","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687072711","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884017111","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904712004","type":"NDC"}],"standard_charges":[{"gross_charge":16.57,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010000201","type":"NDC"}],"standard_charges":[{"gross_charge":2.45,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292005403","type":"NDC"}],"standard_charges":[{"gross_charge":18.78,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42292005401","type":"NDC"}],"standard_charges":[{"gross_charge":18.78,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877058901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687038911","type":"NDC"}],"standard_charges":[{"gross_charge":22.13,"discounted_cash":5.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"254200801","type":"NDC"}],"standard_charges":[{"gross_charge":23.4,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993016502","type":"NDC"}],"standard_charges":[{"gross_charge":23.22,"discounted_cash":5.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"colchicine 0.6 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764011907","type":"NDC"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine benzoate 1 mg/mL suspension 150 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"52652500101","type":"NDC"}],"standard_charges":[{"gross_charge":2543.31,"discounted_cash":635.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"codeine 30 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54024424","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 90 mcg/actuation HFA aerosol inhaler 8.5 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802008801","type":"NDC"}],"standard_charges":[{"gross_charge":230.16,"discounted_cash":57.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 90 mcg/actuation HFA aerosol inhaler 6.7 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"254100752","type":"NDC"}],"standard_charges":[{"gross_charge":138.93,"discounted_cash":34.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 90 mcg/actuation HFA aerosol inhaler 8.5 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"93317431","type":"NDC"}],"standard_charges":[{"gross_charge":256.27,"discounted_cash":64.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.3 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268019415","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.3 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268019411","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.3 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817018210","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.3 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228212910","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079030001","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687012411","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687012401","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228212810","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079029901","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904744261","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.1 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268019215","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268019211","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687011311","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739006010","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228212710","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.3 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079030101","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine HCL 0.3 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904565861","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivaroxaban 2.5 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458057710","type":"NDC"}],"standard_charges":[{"gross_charge":30.72,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivaroxaban 2.5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458057701","type":"NDC"}],"standard_charges":[{"gross_charge":30.72,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 90 mcg/actuation HFA aerosol inhaler 18 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"66993001968","type":"NDC"}],"standard_charges":[{"gross_charge":317.54,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 90 mcg/actuation HFA aerosol inhaler 8.5 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"59310057922","type":"NDC"}],"standard_charges":[{"gross_charge":522.57,"discounted_cash":130.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 90 mcg/actuation HFA aerosol inhaler 8 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"173068221","type":"NDC"}],"standard_charges":[{"gross_charge":144.38,"discounted_cash":36.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 90 mcg/actuation HFA aerosol inhaler 8 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"173068224","type":"NDC"}],"standard_charges":[{"gross_charge":163.07,"discounted_cash":40.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 90 mcg/actuation HFA aerosol inhaler 18 g CANISTER","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"173068220","type":"NDC"}],"standard_charges":[{"gross_charge":413.36,"discounted_cash":103.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetic acid 2 % solution 15 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60432074115","type":"NDC"}],"standard_charges":[{"gross_charge":51.35,"discounted_cash":12.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-racepinep-tetracaine 4-0.05-0.5 % gel 3 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70092161144","type":"NDC"}],"standard_charges":[{"gross_charge":56.45,"discounted_cash":14.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mirtazapine 15 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739009810","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"urea 15 gram powder in packet 8 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62530000011","type":"NDC"}],"standard_charges":[{"gross_charge":19.33,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 1 % cream 45 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"61269022063","type":"NDC"}],"standard_charges":[{"gross_charge":21.36,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 1 % cream 45 g TUBE/KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472022063","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 1 % cream 45 g TUBE/KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472022041","type":"NDC"}],"standard_charges":[{"gross_charge":17.77,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 1 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672127501","type":"NDC"}],"standard_charges":[{"gross_charge":13.1,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 1 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802043401","type":"NDC"}],"standard_charges":[{"gross_charge":12.54,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 1 % cream 14.17 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904782236","type":"NDC"}],"standard_charges":[{"gross_charge":4.11,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 1 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"68462018117","type":"NDC"}],"standard_charges":[{"gross_charge":37.93,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 1 % cream 45 g TUBE/KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672200306","type":"NDC"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prednisoLONE per 5 mg","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"17856081501","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prednisoLONE per 5 mg","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"121475950","type":"NDC"}],"standard_charges":[{"gross_charge":11.38,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prednisoLONE per 5 mg","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"121475905","type":"NDC"}],"standard_charges":[{"gross_charge":11.38,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904672580","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904652261","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904643459","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37864000051","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37864000033","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483008001","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645085110","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645085101","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67618030050","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67618030010","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azilsartan med-chlorthalidone 40-25 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60631042530","type":"NDC"}],"standard_charges":[{"gross_charge":34.87,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"racepinephrine 2.25 % solution for nebulization 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"487278401","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"racepinephrine 2.25 % solution for nebulization 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"487590199","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268005415","type":"NDC"}],"standard_charges":[{"gross_charge":9.59,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268005411","type":"NDC"}],"standard_charges":[{"gross_charge":9.59,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904672559","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904666361","type":"NDC"}],"standard_charges":[{"gross_charge":13.15,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 250 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000044701","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904725260","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nitroglycerin 0.4 % (w/w) ointment 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"58914030180","type":"NDC"}],"standard_charges":[{"gross_charge":2547.09,"discounted_cash":636.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904692561","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687024211","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687024201","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 50 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180035209","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762490003","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 50 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49490030","type":"NDC"}],"standard_charges":[{"gross_charge":60.22,"discounted_cash":15.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904692661","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687025311","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687025301","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 100 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180035309","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084018211","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 100 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180035306","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sertraline 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762491003","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904725261","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"senna 8.6 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000044703","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155028801","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084054111","type":"NDC"}],"standard_charges":[{"gross_charge":14.34,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 300 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687058611","type":"NDC"}],"standard_charges":[{"gross_charge":8.77,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium-benzocaine 283-20 mg/5 mL enema 5 mL Tube","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17433987700","type":"NDC"}],"standard_charges":[{"gross_charge":7.43,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"docusate sodium-benzocaine 283-20 mg/5 mL enema 5 mL Tube","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17433987703","type":"NDC"}],"standard_charges":[{"gross_charge":7.43,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridostigmine 60 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050211","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridostigmine 60 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050201","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridostigmine 60 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904662261","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridostigmine 60 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084049411","type":"NDC"}],"standard_charges":[{"gross_charge":5.53,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridostigmine 60 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682030210","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridostigmine 60 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115351101","type":"NDC"}],"standard_charges":[{"gross_charge":4.19,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 300 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603545021","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 300 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489055301","type":"NDC"}],"standard_charges":[{"gross_charge":9.09,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 300 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559023201","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 150 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603544821","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 150 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687070911","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 150 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687070901","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 150 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687053711","type":"NDC"}],"standard_charges":[{"gross_charge":3.42,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloBAZam 10 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832058011","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloBAZam 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687042311","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloBAZam 10 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687042321","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloBAZam 20 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832058111","type":"NDC"}],"standard_charges":[{"gross_charge":5.01,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687058601","type":"NDC"}],"standard_charges":[{"gross_charge":8.77,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904528261","type":"NDC"}],"standard_charges":[{"gross_charge":3.32,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 300 MG capsule 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180065906","type":"NDC"}],"standard_charges":[{"gross_charge":3.91,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084035811","type":"NDC"}],"standard_charges":[{"gross_charge":6.27,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739041510","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 300 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748001811","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 150 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057521","type":"NDC"}],"standard_charges":[{"gross_charge":13.49,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lurasidone 20 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402030230","type":"NDC"}],"standard_charges":[{"gross_charge":188.99,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 150 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057511","type":"NDC"}],"standard_charges":[{"gross_charge":13.49,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 150 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084035711","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 150 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748001511","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifabutin 150 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180028501","type":"NDC"}],"standard_charges":[{"gross_charge":86.75,"discounted_cash":21.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivaroxaban 20 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458057901","type":"NDC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivaroxaban 20 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458057910","type":"NDC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivaroxaban 15 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458057801","type":"NDC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivaroxaban 15 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458057810","type":"NDC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 150 MG capsule 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180065806","type":"NDC"}],"standard_charges":[{"gross_charge":3.34,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 150 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687053701","type":"NDC"}],"standard_charges":[{"gross_charge":3.42,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lurasidone 20 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877063830","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lurasidone 20 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722008030","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin-dexAMETHasone 0.3-0.1 % drops,suspension 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"gross_charge":197.53,"discounted_cash":49.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin-dexAMETHasone 0.3-0.1 % drops,suspension 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314064725","type":"NDC"}],"standard_charges":[{"gross_charge":148.13,"discounted_cash":37.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin-dexAMETHasone 0.3-0.1 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"65064835","type":"NDC"}],"standard_charges":[{"gross_charge":887.42,"discounted_cash":221.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin-dexAMETHasone 0.3-0.1 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"78087601","type":"NDC"}],"standard_charges":[{"gross_charge":1184.98,"discounted_cash":296.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.5 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314022710","type":"NDC"}],"standard_charges":[{"gross_charge":52.54,"discounted_cash":13.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"gross_charge":30.79,"discounted_cash":7.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.5 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60758080110","type":"NDC"}],"standard_charges":[{"gross_charge":31.29,"discounted_cash":7.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60758080105","type":"NDC"}],"standard_charges":[{"gross_charge":21.38,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.5 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478028811","type":"NDC"}],"standard_charges":[{"gross_charge":39.23,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478028810","type":"NDC"}],"standard_charges":[{"gross_charge":27.43,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.5 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"64980051405","type":"NDC"}],"standard_charges":[{"gross_charge":37.88,"discounted_cash":9.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.5 % drops 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"64980051401","type":"NDC"}],"standard_charges":[{"gross_charge":55.48,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.25 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314022605","type":"NDC"}],"standard_charges":[{"gross_charge":14.49,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.25 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60758080205","type":"NDC"}],"standard_charges":[{"gross_charge":12.14,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"timolol 0.25 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"64980051305","type":"NDC"}],"standard_charges":[{"gross_charge":20.33,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin-dexAMETHasone 0.3-0.1 % drops,suspension 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574403125","type":"NDC"}],"standard_charges":[{"gross_charge":125.24,"discounted_cash":31.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 7.5 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332037931","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 300 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378173001","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 300 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687010011","type":"NDC"}],"standard_charges":[{"gross_charge":21.03,"discounted_cash":5.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zidovudine 10 mg/mL syrup 5 mL Syringe","drug_information":{"unit":0.04167,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710207105","type":"NDC"}],"standard_charges":[{"gross_charge":8.27,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zidovudine 10 mg/mL syrup 240 mL Bottle","drug_information":{"unit":0.04167,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"64376012923","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zidovudine 10 mg/mL syrup 240 mL Bottle","drug_information":{"unit":0.04167,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65862004824","type":"NDC"}],"standard_charges":[{"gross_charge":8.27,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121100","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93171201","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121189","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56016901","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121101","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azelastine-fluticasone 137-50 mcg/spray spray,non-aerosol 23 g SQUEEZ BTL","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"37024523","type":"NDC"}],"standard_charges":[{"gross_charge":874.91,"discounted_cash":218.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin 250 MG capsule 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63323033920","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 300 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904716861","type":"NDC"}],"standard_charges":[{"gross_charge":14.33,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 300 mg capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904716806","type":"NDC"}],"standard_charges":[{"gross_charge":7.33,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 300 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238154001","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 300 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904622161","type":"NDC"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 300 mg capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904622106","type":"NDC"}],"standard_charges":[{"gross_charge":20.13,"discounted_cash":5.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ursodioL 300 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806050301","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 7.5 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739000333","type":"NDC"}],"standard_charges":[{"gross_charge":15.82,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 7.5 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904643604","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 7.5 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084054911","type":"NDC"}],"standard_charges":[{"gross_charge":13.61,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094004359","type":"NDC"}],"standard_charges":[{"gross_charge":38.43,"discounted_cash":9.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 420 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65162006205","type":"NDC"}],"standard_charges":[{"gross_charge":977.26,"discounted_cash":244.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Syringe","drug_information":{"unit":0.02381,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710207906","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689079001","type":"NDC"}],"standard_charges":[{"gross_charge":27.64,"discounted_cash":6.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 420 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"58914017014","type":"NDC"}],"standard_charges":[{"gross_charge":1044.29,"discounted_cash":261.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121074710","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sotalol 80 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505008000","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sotalol 80 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904714361","type":"NDC"}],"standard_charges":[{"gross_charge":4.73,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sotalol 80 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084065411","type":"NDC"}],"standard_charges":[{"gross_charge":5.77,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sotalol 80 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245001289","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphates 19-7 gram/118 mL enema 133 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"67777040201","type":"NDC"}],"standard_charges":[{"gross_charge":3.35,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphates 19-7 gram/118 mL enema 133 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"132020100","type":"NDC"}],"standard_charges":[{"gross_charge":5.03,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphates 19-7 gram/118 mL enema 133 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"12462-0201-","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphates 19-7 gram/118 mL enema 133 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536741551","type":"NDC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphates 19-7 gram/118 mL enema 133 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"132020140","type":"NDC"}],"standard_charges":[{"gross_charge":6.14,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50268073211","type":"NDC"}],"standard_charges":[{"gross_charge":28.52,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50268073212","type":"NDC"}],"standard_charges":[{"gross_charge":28.52,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121074750","type":"NDC"}],"standard_charges":[{"gross_charge":29.23,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69339014801","type":"NDC"}],"standard_charges":[{"gross_charge":40.7,"discounted_cash":10.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 7.5 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406991501","type":"NDC"}],"standard_charges":[{"gross_charge":116.3,"discounted_cash":29.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 1 gram tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93221001","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 1 gram tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687069511","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 1 gram tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687069501","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 1 gram tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739094310","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 1 gram tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079075301","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904747066","type":"NDC"}],"standard_charges":[{"gross_charge":29.11,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lurasidone 20 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904735504","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904747056","type":"NDC"}],"standard_charges":[{"gross_charge":34.27,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63739019372","type":"NDC"}],"standard_charges":[{"gross_charge":37.72,"discounted_cash":9.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687073842","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":8.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50268074511","type":"NDC"}],"standard_charges":[{"gross_charge":26.17,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121097494","type":"NDC"}],"standard_charges":[{"gross_charge":33.22,"discounted_cash":8.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121097410","type":"NDC"}],"standard_charges":[{"gross_charge":24.02,"discounted_cash":6.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 414 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689030516","type":"NDC"}],"standard_charges":[{"gross_charge":415.57,"discounted_cash":103.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69339014817","type":"NDC"}],"standard_charges":[{"gross_charge":40.7,"discounted_cash":10.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sucralfate 100 mg/mL suspension 420 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"82182010614","type":"NDC"}],"standard_charges":[{"gross_charge":478.04,"discounted_cash":119.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zidovudine 10 mg/mL syrup 5 mL Syringe","drug_information":{"unit":0.04167,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710207205","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 150 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651025601","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 25 MG suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672529704","type":"NDC"}],"standard_charges":[{"gross_charge":37.67,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121483905","type":"NDC"}],"standard_charges":[{"gross_charge":16.57,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"64950035405","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689040150","type":"NDC"}],"standard_charges":[{"gross_charge":26.96,"discounted_cash":6.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689040101","type":"NDC"}],"standard_charges":[{"gross_charge":14.53,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217300","type":"NDC"}],"standard_charges":[{"gross_charge":7.23,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217200","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 30 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"71930002330","type":"NDC"}],"standard_charges":[{"gross_charge":439.24,"discounted_cash":109.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 30 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121082601","type":"NDC"}],"standard_charges":[{"gross_charge":138.73,"discounted_cash":34.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710212405","type":"NDC"}],"standard_charges":[{"gross_charge":7.87,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710211500","type":"NDC"}],"standard_charges":[{"gross_charge":11.27,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 30 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"43386092060","type":"NDC"}],"standard_charges":[{"gross_charge":433.57,"discounted_cash":108.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710-2057-","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 0.5 mL Syringe","drug_information":{"unit":0.01667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710205600","type":"NDC"}],"standard_charges":[{"gross_charge":11.27,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 20 mg/mL concentrate 30 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689002530","type":"NDC"}],"standard_charges":[{"gross_charge":698.29,"discounted_cash":174.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 10 mg suppository 12 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904714212","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904682894","type":"NDC"}],"standard_charges":[{"gross_charge":16.53,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 10 mg suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58980041501","type":"NDC"}],"standard_charges":[{"gross_charge":3.53,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687040640","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904682805","type":"NDC"}],"standard_charges":[{"gross_charge":14.6,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARoxetine 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505008302","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etravirine 200 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676057101","type":"NDC"}],"standard_charges":[{"gross_charge":102.23,"discounted_cash":25.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 236-22.74-6.74 -5.86 gram recon soln 4,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"gross_charge":100.8,"discounted_cash":25.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 236-22.74-6.74 -5.86 gram recon soln 4,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"43386009019","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":21.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polyethylene glycol 236-22.74-6.74 -5.86 gram recon soln 4,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"10572010001","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":21.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904696661","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806000501","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162004710","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858000110","type":"NDC"}],"standard_charges":[{"gross_charge":2.93,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858000101","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781026305","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68308050547","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406055223","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084035411","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702001801","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxyCODONE 5 mg/5 mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121482705","type":"NDC"}],"standard_charges":[{"gross_charge":24.34,"discounted_cash":6.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 10 mg suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58980041512","type":"NDC"}],"standard_charges":[{"gross_charge":3.53,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 10 mg suppository 100 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904505860","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 10 mg suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574705012","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 20 mcg/hour patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93365921","type":"NDC"}],"standard_charges":[{"gross_charge":496.87,"discounted_cash":124.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 20 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011075204","type":"NDC"}],"standard_charges":[{"gross_charge":545.5,"discounted_cash":136.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 10 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742037404","type":"NDC"}],"standard_charges":[{"gross_charge":243.87,"discounted_cash":60.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 10 mcg/hour patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742037401","type":"NDC"}],"standard_charges":[{"gross_charge":243.87,"discounted_cash":60.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 10 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93365740","type":"NDC"}],"standard_charges":[{"gross_charge":258.21,"discounted_cash":64.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 10 mcg/hour patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93365721","type":"NDC"}],"standard_charges":[{"gross_charge":258.21,"discounted_cash":64.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 10 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011075104","type":"NDC"}],"standard_charges":[{"gross_charge":306.28,"discounted_cash":76.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 5 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742037204","type":"NDC"}],"standard_charges":[{"gross_charge":162.58,"discounted_cash":40.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 5 mcg/hour patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742037201","type":"NDC"}],"standard_charges":[{"gross_charge":162.58,"discounted_cash":40.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 5 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238120202","type":"NDC"}],"standard_charges":[{"gross_charge":206.84,"discounted_cash":51.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 5 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93365640","type":"NDC"}],"standard_charges":[{"gross_charge":149.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 5 mcg/hour patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93365621","type":"NDC"}],"standard_charges":[{"gross_charge":149.5,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norethindrone ac-eth estradioL 1.5-30 mg-mcg tablet 21 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555902742","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norethindrone ac-eth estradioL 1-20 mg-mcg tablet 21 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378728085","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"norethindrone ac-eth estradioL 1-20 mg-mcg tablet 21 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378728053","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 20 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93365940","type":"NDC"}],"standard_charges":[{"gross_charge":496.87,"discounted_cash":124.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 20 mcg/hour patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742037601","type":"NDC"}],"standard_charges":[{"gross_charge":345.38,"discounted_cash":86.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 20 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742037604","type":"NDC"}],"standard_charges":[{"gross_charge":345.38,"discounted_cash":86.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lurasidone 40 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402030401","type":"NDC"}],"standard_charges":[{"gross_charge":135.8,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 10 mg suppository 28 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81421002105","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 10 mg suppository 16 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81421002103","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 10 mg suppository 8 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81421002102","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 5 mg tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904640761","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bisacodyL 5 mg tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904792760","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 8 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904655261","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 8 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084022111","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARoxetine 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079077401","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 8 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084022101","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904655161","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 4 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084022011","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084022001","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 4 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862018730","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 4 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304045830","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lurasidone 40 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904735661","type":"NDC"}],"standard_charges":[{"gross_charge":4.73,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lurasidone 40 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402030430","type":"NDC"}],"standard_charges":[{"gross_charge":188.99,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron 8 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079052501","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propafenone 150 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591058201","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARoxetine 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084004511","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bismuth subsalicylate 262 mg/15 mL suspension 30 mL Syringe","drug_information":{"unit":0.25424,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201709","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pravastatin 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904589261","type":"NDC"}],"standard_charges":[{"gross_charge":2.86,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pravastatin 20 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462019690","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pravastatin 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079045801","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pravastatin 20 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93720198","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pravastatin 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687016911","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pravastatin 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904589161","type":"NDC"}],"standard_charges":[{"gross_charge":2.45,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 12.5 mL Syringe","drug_information":{"unit":0.26667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217607","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.66667,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710217505","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 12.5 mL Syringe","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710215607","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710215505","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 60 mL Bottle","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93818064","type":"NDC"}],"standard_charges":[{"gross_charge":9.11,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 60 mL Bottle","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68180067801","type":"NDC"}],"standard_charges":[{"gross_charge":5.98,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 12.5 mL Syringe","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213007","type":"NDC"}],"standard_charges":[{"gross_charge":26.46,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710212805","type":"NDC"}],"standard_charges":[{"gross_charge":26.46,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 60 mL Bottle","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"47781038426","type":"NDC"}],"standard_charges":[{"gross_charge":21.76,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pravastatin 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687017801","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 12.5 mL Syringe","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710207807","type":"NDC"}],"standard_charges":[{"gross_charge":26.46,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pravastatin 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687017811","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"praziquanteL 600 mg tablet 6 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50419074701","type":"NDC"}],"standard_charges":[{"gross_charge":591.99,"discounted_cash":148.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 25 MG suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"713052606","type":"NDC"}],"standard_charges":[{"gross_charge":22.44,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 25 MG suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672529701","type":"NDC"}],"standard_charges":[{"gross_charge":37.67,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 25 MG suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"713052612","type":"NDC"}],"standard_charges":[{"gross_charge":22.44,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 12.5 MG suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802075830","type":"NDC"}],"standard_charges":[{"gross_charge":38.07,"discounted_cash":9.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 12.5 MG suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672529605","type":"NDC"}],"standard_charges":[{"gross_charge":37.67,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 12.5 MG suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"713053606","type":"NDC"}],"standard_charges":[{"gross_charge":24.57,"discounted_cash":6.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 12.5 MG suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672529601","type":"NDC"}],"standard_charges":[{"gross_charge":37.67,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 12.5 MG suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"713053612","type":"NDC"}],"standard_charges":[{"gross_charge":24.57,"discounted_cash":6.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine 12.5 MG suppository 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802075800","type":"NDC"}],"standard_charges":[{"gross_charge":38.07,"discounted_cash":9.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 25 MG suppository 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"713013506","type":"NDC"}],"standard_charges":[{"gross_charge":44.64,"discounted_cash":11.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 25 MG suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574722612","type":"NDC"}],"standard_charges":[{"gross_charge":34.76,"discounted_cash":8.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"primidone 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268068611","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"primidone 50 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268068615","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"primidone 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084020211","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc oxide-cod liver oil 40 % paste 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"69968006101","type":"NDC"}],"standard_charges":[{"gross_charge":13.99,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pravastatin 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687089711","type":"NDC"}],"standard_charges":[{"gross_charge":3.09,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710200505","type":"NDC"}],"standard_charges":[{"gross_charge":32.98,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 6 mg/mL suspension for reconstitution 60 mL Bottle","drug_information":{"unit":0.05556,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"4082205","type":"NDC"}],"standard_charges":[{"gross_charge":33.54,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pramoxine 1 % lotion 222 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"316023075","type":"NDC"}],"standard_charges":[{"gross_charge":30.77,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenelzine 15 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762011901","type":"NDC"}],"standard_charges":[{"gross_charge":3.1,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenelzine 15 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386036021","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenelzine 15 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71035060","type":"NDC"}],"standard_charges":[{"gross_charge":11.24,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"permethrin 1 % liquid 59 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"472524267","type":"NDC"}],"standard_charges":[{"gross_charge":26.27,"discounted_cash":6.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"permethrin 1 % liquid 59 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63736012002","type":"NDC"}],"standard_charges":[{"gross_charge":47.58,"discounted_cash":11.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"permethrin 5 % cream 60 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802026937","type":"NDC"}],"standard_charges":[{"gross_charge":386.82,"discounted_cash":96.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"permethrin 5 % cream 60 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"21922002107","type":"NDC"}],"standard_charges":[{"gross_charge":90.22,"discounted_cash":22.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"permethrin 5 % cream 60 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472024260","type":"NDC"}],"standard_charges":[{"gross_charge":519.62,"discounted_cash":129.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bismuth subsalicylate 262 mg/15 mL suspension 473 mL Bottle","drug_information":{"unit":0.06342,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"37000003204","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bismuth subsalicylate 262 mg/15 mL suspension 118 mL Bottle","drug_information":{"unit":0.25424,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"37000003201","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bismuth subsalicylate 262 mg/15 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121091040","type":"NDC"}],"standard_charges":[{"gross_charge":16.38,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bismuth subsalicylate 262 mg/15 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121091030","type":"NDC"}],"standard_charges":[{"gross_charge":16.38,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bismuth subsalicylate 262 mg/15 mL suspension 30 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710211009","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bismuth subsalicylate 262 mg/15 mL suspension 473 mL Bottle","drug_information":{"unit":0.06342,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"1490003916","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bismuth subsalicylate 262 mg/15 mL suspension 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"1490003904","type":"NDC"}],"standard_charges":[{"gross_charge":8.43,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vilazodone 40 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456114030","type":"NDC"}],"standard_charges":[{"gross_charge":48.32,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linaGLIPtin 5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"597014030","type":"NDC"}],"standard_charges":[{"gross_charge":62.62,"discounted_cash":15.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linaGLIPtin 5 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"597014090","type":"NDC"}],"standard_charges":[{"gross_charge":62.62,"discounted_cash":15.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linaGLIPtin 5 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"597014061","type":"NDC"}],"standard_charges":[{"gross_charge":56.92,"discounted_cash":14.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Potassium Phosphate-Sodium Phosphate 250 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980010401","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Potassium Phosphate-Sodium Phosphate 250 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39328010710","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ticagrelor 90 mg tablet 60 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687092857","type":"NDC"}],"standard_charges":[{"gross_charge":15.56,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ticagrelor 90 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687092811","type":"NDC"}],"standard_charges":[{"gross_charge":15.56,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ticagrelor 90 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"186077739","type":"NDC"}],"standard_charges":[{"gross_charge":31.64,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fidaxomicin 200 mg tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52015008001","type":"NDC"}],"standard_charges":[{"gross_charge":1035.57,"discounted_cash":258.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"loteprednol etabonate 0.5 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24208044335","type":"NDC"}],"standard_charges":[{"gross_charge":1448.96,"discounted_cash":362.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARoxetine 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904567761","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivaroxaban 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458058001","type":"NDC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivaroxaban 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458058010","type":"NDC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 50 mg tablet,chewable 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71000740","type":"NDC"}],"standard_charges":[{"gross_charge":10.39,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 50 mg tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980057301","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 50 mg tablet,chewable 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687015695","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 50 mg tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672414601","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 50 mg tablet,chewable 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079012901","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenytoin 50 mg tablet,chewable 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079012906","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivaroxaban 10 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458058030","type":"NDC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prazosin 5 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079063201","type":"NDC"}],"standard_charges":[{"gross_charge":16.61,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079072501","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 10 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668000801","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 83-15 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904516838","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium phosphates 9.5-3.5 gram/59 mL enema 66 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"132020220","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 1 gram tablet,soluble 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333084425","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 1 gram tablet,soluble 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433012810","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 1 gram tablet,soluble 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433012801","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 1 gram tablet,soluble 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904723961","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 1 gram tablet,soluble 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367022001","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 1 gram tablet,soluble 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"223176001","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"B complex-vitamin C-folic acid 100-1 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10542001010","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"saliva substitute combo no.2 solution 30 mL AMPUL/KIT","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710222709","type":"NDC"}],"standard_charges":[{"gross_charge":41.96,"discounted_cash":10.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"saliva substitute combo no.2 solution 15 mL Packet","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60146029312","type":"NDC"}],"standard_charges":[{"gross_charge":41.96,"discounted_cash":10.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"saliva substitute combo no.2 solution 15 mL AMPUL/KIT","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60146029157","type":"NDC"}],"standard_charges":[{"gross_charge":38.81,"discounted_cash":9.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"saliva substitute combo no.2 solution 30 mL AMPUL/KIT","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216609","type":"NDC"}],"standard_charges":[{"gross_charge":35.41,"discounted_cash":8.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"saliva substitute combo no.2 solution 960 mL Box","drug_information":{"unit":0.03125,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"73090800002","type":"NDC"}],"standard_charges":[{"gross_charge":40.82,"discounted_cash":10.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"witch hazel-glycerin 12.5-50 % pads, medicated 40 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50289325001","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 83-15 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904648838","type":"NDC"}],"standard_charges":[{"gross_charge":23.02,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"compound veh.susp sugar-free 1 (Ora-Blend) suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574031216","type":"NDC"}],"standard_charges":[{"gross_charge":81.45,"discounted_cash":20.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 83-15 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904754012","type":"NDC"}],"standard_charges":[{"gross_charge":29.69,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"469061773","type":"NDC"}],"standard_charges":[{"gross_charge":30.42,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 94-3 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"65050935","type":"NDC"}],"standard_charges":[{"gross_charge":48.76,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"904709761","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"64380072106","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"16729004201","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"68084045011","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tacrolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7507","type":"HCPCS"},{"code":"51079081801","type":"NDC"}],"standard_charges":[{"gross_charge":6.06,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 83-15 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"17478006235","type":"NDC"}],"standard_charges":[{"gross_charge":38.13,"discounted_cash":9.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ginger gum gum 1 each Package","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710101101","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ginger gum gum 24 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"8727000003","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoaL 25 gram/120 mL suspension 120 mL Tube","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574052174","type":"NDC"}],"standard_charges":[{"gross_charge":65.02,"discounted_cash":16.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"flavoring agent (bulk) oil 29.5 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"23535007005","type":"NDC"}],"standard_charges":[{"gross_charge":43.61,"discounted_cash":10.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil-white petrolatum 41 % ointment 396 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"72140063386","type":"NDC"}],"standard_charges":[{"gross_charge":59.88,"discounted_cash":14.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil-white petrolatum 41 % ointment 198 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"72140001945","type":"NDC"}],"standard_charges":[{"gross_charge":59.04,"discounted_cash":14.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil-white petrolatum 41 % ointment 0.9 g Package","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"7214000674","type":"NDC"}],"standard_charges":[{"gross_charge":0.87,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mineral oil-white petrolatum 41 % ointment 10 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"72140011047","type":"NDC"}],"standard_charges":[{"gross_charge":13.06,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687039479","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"378797031","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"378797055","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204010001","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204010030","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204010025","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487980160","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487980101","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487980125","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextroamphetamine-amphetamine 5 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64850050001","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc-polymyxin B 500-10,000 unit/gram ointment 28.3 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"810079887","type":"NDC"}],"standard_charges":[{"gross_charge":43.03,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc-polymyxin B 500-10,000 unit/gram ointment 14.2 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"810079888","type":"NDC"}],"standard_charges":[{"gross_charge":26.72,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc-polymyxin B 500-10,000 unit/gram ointment 28.4 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672204402","type":"NDC"}],"standard_charges":[{"gross_charge":28.87,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc-polymyxin B 500-10,000 unit/gram ointment 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536117428","type":"NDC"}],"standard_charges":[{"gross_charge":27.17,"discounted_cash":6.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoaL 25 gram/120 mL suspension 120 mL Tube","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574012174","type":"NDC"}],"standard_charges":[{"gross_charge":56.45,"discounted_cash":14.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoaL 25 gram/120 mL suspension 120 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574012104","type":"NDC"}],"standard_charges":[{"gross_charge":56.45,"discounted_cash":14.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoaL 25 gram/120 mL suspension 120 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689020204","type":"NDC"}],"standard_charges":[{"gross_charge":97.27,"discounted_cash":24.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoal-sorbitoL 25 gram/120 mL suspension 120 mL Tube","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574052074","type":"NDC"}],"standard_charges":[{"gross_charge":59.47,"discounted_cash":14.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoal-sorbitoL 25 gram/120 mL suspension 120 mL Tube","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574012074","type":"NDC"}],"standard_charges":[{"gross_charge":56.45,"discounted_cash":14.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoal-sorbitoL 25 gram/120 mL suspension 120 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574012004","type":"NDC"}],"standard_charges":[{"gross_charge":56.45,"discounted_cash":14.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoal-sorbitoL 25 gram/120 mL suspension 120 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689020304","type":"NDC"}],"standard_charges":[{"gross_charge":84.67,"discounted_cash":21.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 94-3 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"65051801","type":"NDC"}],"standard_charges":[{"gross_charge":38.09,"discounted_cash":9.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg/0.5 mL solution for nebulization 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76204002711","type":"NDC"}],"standard_charges":[{"gross_charge":6.84,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg/0.5 mL solution for nebulization 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135082984","type":"NDC"}],"standard_charges":[{"gross_charge":17.71,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg/0.5 mL solution for nebulization 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710301001","type":"NDC"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg/0.5 mL solution for nebulization 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"97710300501","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg/0.5 mL solution for nebulization 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"487990130","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc-polymyxin B 500-10,000 unit/gram ointment 14 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"70000009301","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc-polymyxin B 500-10,000 unit/gram ointment 28 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"70000007001","type":"NDC"}],"standard_charges":[{"gross_charge":16.35,"discounted_cash":4.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin zinc-polymyxin B 500-10,000 unit/gram ointment 28.4 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"70000047101","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albuterol 2.5 mg/0.5 mL solution for nebulization 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76204002701","type":"NDC"}],"standard_charges":[{"gross_charge":6.84,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextroamphetamine-amphetamine 5 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781017401","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"saliva stimulant spray,non-aerosol 44.3 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"48582000155","type":"NDC"}],"standard_charges":[{"gross_charge":39.7,"discounted_cash":9.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valACYclovir 1000 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237004330","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valACYclovir 1000 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378427693","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetracaine HCl (PF) 0.5 % drops 4 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65074114","type":"NDC"}],"standard_charges":[{"gross_charge":51.79,"discounted_cash":12.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 10 mg/5 mL (2 mg/mL) syrup 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904711341","type":"NDC"}],"standard_charges":[{"gross_charge":25.2,"discounted_cash":6.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 10 mg/5 mL (2 mg/mL) syrup 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057640","type":"NDC"}],"standard_charges":[{"gross_charge":28.16,"discounted_cash":7.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 10 mg/5 mL (2 mg/mL) syrup 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710210005","type":"NDC"}],"standard_charges":[{"gross_charge":20.03,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 10 mg/5 mL (2 mg/mL) syrup 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68094076459","type":"NDC"}],"standard_charges":[{"gross_charge":28.22,"discounted_cash":7.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine mononitrate (vit B1) 100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896085101","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 240 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834015901","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 240 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664011888","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 240 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462026001","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycerin 2.8 gram/2.7 mL solution 4 mL SQUEEZ BTL","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"132019012","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 57.3-42.5 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"23066704","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 57.3-42.5 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"70000051301","type":"NDC"}],"standard_charges":[{"gross_charge":17.64,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 57.3-42.5 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"230066704","type":"NDC"}],"standard_charges":[{"gross_charge":38.13,"discounted_cash":9.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valACYclovir 500 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378427593","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"white petrolatum-mineral oiL 57.3-42.5 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"23024004","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valACYclovir 500 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237004230","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valACYclovir 500 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904656507","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prednisoLONE per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"17856075905","type":"NDC"}],"standard_charges":[{"gross_charge":7.94,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL (5 mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42192060845","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL (5 mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42192060805","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gabapentin 250 mg/5 mL (5 mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383031107","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 120 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049311","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 120 MG tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049301","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamil SR 120 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462029201","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNV no.95-ferrous fumarate-FA 28 mg iron- 800 mcg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"96295012831","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNV no.95-ferrous fumarate-FA 28 mg iron- 800 mcg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37864083701","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNV no.95-ferrous fumarate-FA 28 mg iron- 800 mcg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536408501","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNV no.95-ferrous fumarate-FA 28 mg iron- 800 mcg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645083701","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valACYclovir 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904656561","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lactobacillus acidoph-L.bulgar 1 million cell tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333044125","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lactobacillus acidoph-L.bulgar 1 million cell tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333044110","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lactobacillus acidoph-L.bulgar 1 million cell tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856012920","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL (5 mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904706094","type":"NDC"}],"standard_charges":[{"gross_charge":9.62,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL (5 mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904706041","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg/5 mL (1,250 mg/5 mL) suspension 5 mL Cup","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710208005","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg/5 mL (1,250 mg/5 mL) suspension 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121476605","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg/5 mL (1,250 mg/5 mL) suspension 473 mL Bottle","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121076616","type":"NDC"}],"standard_charges":[{"gross_charge":0.4,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam 500 mg/5 mL (5 mL) solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63739015870","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":14.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Lactobacillus acidoph-L.bulgar 1 million cell tablet 50 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980012950","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thyroid (pork) 120 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456046101","type":"NDC"}],"standard_charges":[{"gross_charge":9.19,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thyroid (pork) 60 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192033001","type":"NDC"}],"standard_charges":[{"gross_charge":4.21,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thyroid (pork) 60 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456045901","type":"NDC"}],"standard_charges":[{"gross_charge":5.46,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thyroid (pork) 30 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456045801","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"compounding vehicle SF no.9 (Ora-Sweet) liquid 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574030216","type":"NDC"}],"standard_charges":[{"gross_charge":83.44,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"compounding vehicle SF no.9 (Ora-Sweet) liquid 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"395009416","type":"NDC"}],"standard_charges":[{"gross_charge":63.57,"discounted_cash":15.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine HCL 2 % jelly in applicator 10 mL Syringe","drug_information":{"unit":1.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"gross_charge":37.05,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin with minerals 9 mg iron-400 mcg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904549261","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin with minerals 9 mg iron-400 mcg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333086110","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin with minerals 9 mg iron-400 mcg tablet 130 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681016000","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin with minerals 9 mg iron-400 mcg tablet 130 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"40985022368","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg calcium (1,250 mg) tablet 150 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555000301","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg calcium (1,250 mg) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904188361","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg calcium (1,250 mg) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645082799","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg calcium (1,250 mg) tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37864082799","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"multivitamin with minerals 9 mg iron-400 mcg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333086125","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 10 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862016001","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904755972","type":"NDC"}],"standard_charges":[{"gross_charge":5.54,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904753315","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664039688","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155025001","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084089695","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664039288","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155024601","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone furoate-vilanteroL 100-25 mcg/dose blister with device 28 each BLIST PACK","drug_information":{"unit":28.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"173085914","type":"NDC"}],"standard_charges":[{"gross_charge":399.13,"discounted_cash":99.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 25 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904737661","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 25 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687073011","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 25 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687073001","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 25 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904651761","type":"NDC"}],"standard_charges":[{"gross_charge":2.61,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 25 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268052311","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 25 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268052315","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 25 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084049111","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 25 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746012106","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 12.5 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904737561","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237017601","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 12.5 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904651661","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 75 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079048201","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 75 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084085611","type":"NDC"}],"standard_charges":[{"gross_charge":4.26,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 4 mL Vial","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"517760401","type":"NDC"}],"standard_charges":[{"gross_charge":34.32,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710300601","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 4 mL Vial","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069404","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 10 mL Vial","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069210","type":"NDC"}],"standard_charges":[{"gross_charge":5.21,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 30 mL Vial","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 30 mL Vial","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"409330803","type":"NDC"}],"standard_charges":[{"gross_charge":4.11,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 15 mcg/hour patch weekly 4 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93365840","type":"NDC"}],"standard_charges":[{"gross_charge":344.81,"discounted_cash":86.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine 15 mcg/hour patch weekly 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93365821","type":"NDC"}],"standard_charges":[{"gross_charge":344.81,"discounted_cash":86.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alum, ammonium (bulk) powder 340 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"395004912","type":"NDC"}],"standard_charges":[{"gross_charge":71.4,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dornase alfa 1 mg/mL solution 2.5 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50242010039","type":"NDC"}],"standard_charges":[{"gross_charge":531.79,"discounted_cash":132.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 37.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237017301","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 37.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664039388","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 37.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079048001","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 75 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237017501","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"venlafaxine 75 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664039588","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 12.5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079042301","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 12.5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268052211","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 12.5 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268052215","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 30 MG tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904655861","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 30 MG tablet extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304045101","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 30 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406833023","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 30 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084040411","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":1.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"elviteg-cob-emtri-tenofo DISOP 150-150-200-300 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958120101","type":"NDC"}],"standard_charges":[{"gross_charge":603.7,"discounted_cash":150.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687083801","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687083811","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24540131","type":"NDC"}],"standard_charges":[{"gross_charge":86.42,"discounted_cash":21.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084018911","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904608261","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668000701","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079072420","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079072401","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93007301","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zolpidem 10 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739052610","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 30 MG tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739072610","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darunavir 100 mg/mL suspension 200 mL Bottle","drug_information":{"unit":0.03,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54569640300","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":23.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"apixaban 2.5 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3089331","type":"NDC"}],"standard_charges":[{"gross_charge":31.13,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"icosapent ethyL 1 gram capsule 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52937000120","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meclizine 12.5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084049011","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alogliptin 25 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802015065","type":"NDC"}],"standard_charges":[{"gross_charge":24.29,"discounted_cash":6.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alogliptin 25 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764025030","type":"NDC"}],"standard_charges":[{"gross_charge":54.37,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alogliptin 12.5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802010365","type":"NDC"}],"standard_charges":[{"gross_charge":26.38,"discounted_cash":6.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alogliptin 12.5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764012530","type":"NDC"}],"standard_charges":[{"gross_charge":54.37,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alogliptin 6.25 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802008765","type":"NDC"}],"standard_charges":[{"gross_charge":24.6,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alogliptin 6.25 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764062530","type":"NDC"}],"standard_charges":[{"gross_charge":54.37,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 30 mL Vial","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069041","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"apixaban 5 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3089431","type":"NDC"}],"standard_charges":[{"gross_charge":31.13,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 15 MG tablet extended release 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904655761","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 15 MG tablet extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406831523","type":"NDC"}],"standard_charges":[{"gross_charge":4.34,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darunavir 800 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676056630","type":"NDC"}],"standard_charges":[{"gross_charge":537.27,"discounted_cash":134.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 12-3 mg film 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742036530","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 12-3 mg film 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742036501","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 12-3 mg film 30 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598058130","type":"NDC"}],"standard_charges":[{"gross_charge":33.93,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine-naloxone 12-3 mg film 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598058101","type":"NDC"}],"standard_charges":[{"gross_charge":33.93,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"apixaban 5 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3089421","type":"NDC"}],"standard_charges":[{"gross_charge":31.13,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904755966","type":"NDC"}],"standard_charges":[{"gross_charge":5.54,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 4 mL Vial","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069441","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 30 mL Vial","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069044","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine viscous 2 % solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121495015","type":"NDC"}],"standard_charges":[{"gross_charge":28.35,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine viscous 2 % solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856013801","type":"NDC"}],"standard_charges":[{"gross_charge":18.08,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine viscous 2 % solution 100 mL Bottle","drug_information":{"unit":0.15,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"gross_charge":11.72,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine viscous 2 % solution 20 mL Cup","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856600203","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine viscous 2 % solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121090340","type":"NDC"}],"standard_charges":[{"gross_charge":14.43,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine viscous 2 % solution 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121090315","type":"NDC"}],"standard_charges":[{"gross_charge":14.43,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine viscous 2 % solution 20 mL Syringe","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710204608","type":"NDC"}],"standard_charges":[{"gross_charge":9.24,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine viscous 2 % solution 20 mL Cup","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856077502","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 1 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"225081047","type":"NDC"}],"standard_charges":[{"gross_charge":20.73,"discounted_cash":5.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 1 % spray,non-aerosol 30 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"96295012941","type":"NDC"}],"standard_charges":[{"gross_charge":8.19,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 1 % spray,non-aerosol 30 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000013201","type":"NDC"}],"standard_charges":[{"gross_charge":8.95,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 1 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69536010015","type":"NDC"}],"standard_charges":[{"gross_charge":15.81,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 1 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50323000604","type":"NDC"}],"standard_charges":[{"gross_charge":1901.97,"discounted_cash":475.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 1 % spray,non-aerosol 15 mL SQUEEZ BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24135202","type":"NDC"}],"standard_charges":[{"gross_charge":18.21,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"belladonna alkaloids-opium 16.2-30 mg suppository 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574704501","type":"NDC"}],"standard_charges":[{"gross_charge":94.38,"discounted_cash":23.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine viscous 2 % solution 100 mL Bottle","drug_information":{"unit":0.15,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54350049","type":"NDC"}],"standard_charges":[{"gross_charge":6.43,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"belladonna alkaloids-opium 16.2-30 mg suppository 12 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574704512","type":"NDC"}],"standard_charges":[{"gross_charge":94.38,"discounted_cash":23.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"miconazole 200 mg suppository 3 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"472173803","type":"NDC"}],"standard_charges":[{"gross_charge":47.62,"discounted_cash":11.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin 0.3 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"65064435","type":"NDC"}],"standard_charges":[{"gross_charge":837.9,"discounted_cash":209.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687083056","type":"NDC"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687083042","type":"NDC"}],"standard_charges":[{"gross_charge":9.07,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904732466","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69339015201","type":"NDC"}],"standard_charges":[{"gross_charge":9.87,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121173010","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687026756","type":"NDC"}],"standard_charges":[{"gross_charge":5.08,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687026742","type":"NDC"}],"standard_charges":[{"gross_charge":5.08,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 237 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000047402","type":"NDC"}],"standard_charges":[{"gross_charge":17.92,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000047401","type":"NDC"}],"standard_charges":[{"gross_charge":9.42,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904698520","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904698516","type":"NDC"}],"standard_charges":[{"gross_charge":9.93,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 236 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"96295013127","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 236 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000024502","type":"NDC"}],"standard_charges":[{"gross_charge":14.87,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904517416","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE 12.5 mg/5 mL liquid 236 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50580053408","type":"NDC"}],"standard_charges":[{"gross_charge":44.6,"discounted_cash":11.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin 0.3 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"78081301","type":"NDC"}],"standard_charges":[{"gross_charge":1113.08,"discounted_cash":278.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904732762","type":"NDC"}],"standard_charges":[{"gross_charge":4.03,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"57237031431","type":"NDC"}],"standard_charges":[{"gross_charge":4.54,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"57237031403","type":"NDC"}],"standard_charges":[{"gross_charge":4.54,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levOCARNitine 100 mg/mL solution 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54482014801","type":"NDC"}],"standard_charges":[{"gross_charge":201.71,"discounted_cash":50.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levomilnacipran 40 mg capsule,extended release 24 hr 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456224030","type":"NDC"}],"standard_charges":[{"gross_charge":69.72,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"perampaneL 2 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62856027230","type":"NDC"}],"standard_charges":[{"gross_charge":147.78,"discounted_cash":36.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314064305","type":"NDC"}],"standard_charges":[{"gross_charge":60.56,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208029005","type":"NDC"}],"standard_charges":[{"gross_charge":46.87,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478029010","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin 0.3 % drops 5 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62332051805","type":"NDC"}],"standard_charges":[{"gross_charge":30.16,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"gross_charge":19.49,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-colist-HC-thonzonium 3.3-3-10-0.5 mg/mL drops,suspension 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63481052910","type":"NDC"}],"standard_charges":[{"gross_charge":902.45,"discounted_cash":225.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-colist-HC-thonzonium 3.3-3-10-0.5 mg/mL drops,suspension 10 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63481042105","type":"NDC"}],"standard_charges":[{"gross_charge":882.84,"discounted_cash":220.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"codeine-butalbital-ASA-caff 30-50-325-40 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991007401","type":"NDC"}],"standard_charges":[{"gross_charge":8.27,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"codeine-butalbital-ASA-caff 30-50-325-40 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591354601","type":"NDC"}],"standard_charges":[{"gross_charge":7.41,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"codeine-butalbital-ASA-caff 30-50-325-40 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52544095601","type":"NDC"}],"standard_charges":[{"gross_charge":45.1,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 4 mL Vial","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069422","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 30 mL Vial","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"409330811","type":"NDC"}],"standard_charges":[{"gross_charge":6.59,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE intensol per 1 mg","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"97710206201","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE intensol per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"97710219401","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE intensol per 1 mg","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"54372144","type":"NDC"}],"standard_charges":[{"gross_charge":17.54,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liraglutide 0.6 mg/0.1 mL (18 mg/3 mL) pen injector 3 mL Syringe","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"169406012","type":"NDC"}],"standard_charges":[{"gross_charge":36.01,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69339015301","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687042945","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904684673","type":"NDC"}],"standard_charges":[{"gross_charge":9.07,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689005399","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689005301","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL Syringe","drug_information":{"unit":0.06342,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710208609","type":"NDC"}],"standard_charges":[{"gross_charge":0.5,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":0.06342,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536247085","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine 200 mg/mL solution 4 mL Vial","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63323069444","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium hydroxide 400 mg/5 mL suspension 30 mL BLIST PACK","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121043130","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextroamphetamine-amphetamine 30 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"185209901","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextroamphetamine-amphetamine 30 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555097402","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"posaconazole 100 mg tablet,delayed release (DR/EC) 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70748025807","type":"NDC"}],"standard_charges":[{"gross_charge":45.29,"discounted_cash":11.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"posaconazole 100 mg tablet,delayed release (DR/EC) 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"85432402","type":"NDC"}],"standard_charges":[{"gross_charge":489.24,"discounted_cash":122.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954056410","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555089902","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"liraglutide 0.6 mg/0.1 mL (18 mg/3 mL) pen injector 3 mL Syringe","drug_information":{"unit":0.03333,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"169406013","type":"NDC"}],"standard_charges":[{"gross_charge":36.01,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"umeclidinium-vilanteroL 62.5-25 mcg/actuation blister with device 14 each BLIST PACK","drug_information":{"unit":14.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"173086906","type":"NDC"}],"standard_charges":[{"gross_charge":265.78,"discounted_cash":66.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prednisoLONE acetate 1 % drops,suspension 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"11980018005","type":"NDC"}],"standard_charges":[{"gross_charge":580.78,"discounted_cash":145.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prednisoLONE acetate 1 % drops,suspension 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60758011905","type":"NDC"}],"standard_charges":[{"gross_charge":171.86,"discounted_cash":42.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prednisoLONE acetate 1 % drops,suspension 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"gross_charge":161.7,"discounted_cash":40.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"55150040201","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001001","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001003","type":"NDC"}],"standard_charges":[{"gross_charge":180.93,"discounted_cash":45.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"409120715","type":"NDC"}],"standard_charges":[{"gross_charge":6.43,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"409120713","type":"NDC"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":6.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"409120725","type":"NDC"}],"standard_charges":[{"gross_charge":6.43,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001094","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"409120703","type":"NDC"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":6.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin PF per 80 mg","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"gross_charge":60.3,"discounted_cash":15.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin PF per 80 mg","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323017301","type":"NDC"}],"standard_charges":[{"gross_charge":60.3,"discounted_cash":15.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin PF per 80 mg","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323017394","type":"NDC"}],"standard_charges":[{"gross_charge":42.77,"discounted_cash":10.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pamidronate 60 mg/10 mL (6 mg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703032518","type":"NDC"}],"standard_charges":[{"gross_charge":313.75,"discounted_cash":78.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5 mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935022710","type":"NDC"}],"standard_charges":[{"gross_charge":10353.87,"discounted_cash":2588.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rasburicase per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"24515411","type":"NDC"}],"standard_charges":[{"gross_charge":8333.37,"discounted_cash":2083.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rasburicase per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"24515010","type":"NDC"}],"standard_charges":[{"gross_charge":8333.37,"discounted_cash":2083.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"55150040225","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rasburicase per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"24515011","type":"NDC"}],"standard_charges":[{"gross_charge":8333.37,"discounted_cash":2083.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam-D5W per 1.125 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"206886001","type":"NDC"}],"standard_charges":[{"gross_charge":116.82,"discounted_cash":29.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"54288010001","type":"NDC"}],"standard_charges":[{"gross_charge":67.79,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"16729024231","type":"NDC"}],"standard_charges":[{"gross_charge":84.34,"discounted_cash":21.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"409421501","type":"NDC"}],"standard_charges":[{"gross_charge":280.82,"discounted_cash":70.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"23155017031","type":"NDC"}],"standard_charges":[{"gross_charge":281.66,"discounted_cash":70.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111068507","type":"NDC"}],"standard_charges":[{"gross_charge":534.29,"discounted_cash":133.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021080166","type":"NDC"}],"standard_charges":[{"gross_charge":1392.59,"discounted_cash":348.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"10019007587","type":"NDC"}],"standard_charges":[{"gross_charge":984.31,"discounted_cash":246.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"67457065810","type":"NDC"}],"standard_charges":[{"gross_charge":457.3,"discounted_cash":114.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"10019066610","type":"NDC"}],"standard_charges":[{"gross_charge":1758.74,"discounted_cash":439.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5 mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935030529","type":"NDC"}],"standard_charges":[{"gross_charge":4596.0,"discounted_cash":1149.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5 mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935030330","type":"NDC"}],"standard_charges":[{"gross_charge":4596.0,"discounted_cash":1149.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam-D5W per 1.125 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"338963624","type":"NDC"}],"standard_charges":[{"gross_charge":71.62,"discounted_cash":17.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam-D5W per 1.125 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"338963601","type":"NDC"}],"standard_charges":[{"gross_charge":71.62,"discounted_cash":17.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam-D5W per 1.125 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"97710506501","type":"NDC"}],"standard_charges":[{"gross_charge":61.28,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam-D5W per 1.125 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"206886101","type":"NDC"}],"standard_charges":[{"gross_charge":155.5,"discounted_cash":38.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"gross_charge":180.93,"discounted_cash":45.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"409421505","type":"NDC"}],"standard_charges":[{"gross_charge":47.95,"discounted_cash":11.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"49392083","type":"NDC"}],"standard_charges":[{"gross_charge":459.97,"discounted_cash":114.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"72266016001","type":"NDC"}],"standard_charges":[{"gross_charge":92.48,"discounted_cash":23.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288020304","type":"NDC"}],"standard_charges":[{"gross_charge":3.22,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288020303","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288020302","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860030242","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860030241","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860030204","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860030202","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729050243","type":"NDC"}],"standard_charges":[{"gross_charge":0.8,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729050203","type":"NDC"}],"standard_charges":[{"gross_charge":0.8,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729050164","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729050143","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729050030","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729050008","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021031110","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021031104","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288020305","type":"NDC"}],"standard_charges":[{"gross_charge":3.22,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"72266016010","type":"NDC"}],"standard_charges":[{"gross_charge":92.48,"discounted_cash":23.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288020310","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143915601","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"43598084858","type":"NDC"}],"standard_charges":[{"gross_charge":93.53,"discounted_cash":23.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"43598084811","type":"NDC"}],"standard_charges":[{"gross_charge":93.53,"discounted_cash":23.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"49120301","type":"NDC"}],"standard_charges":[{"gross_charge":245.9,"discounted_cash":61.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"49120310","type":"NDC"}],"standard_charges":[{"gross_charge":245.9,"discounted_cash":61.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziprasidone per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3486","type":"HCPCS"},{"code":"49392020","type":"NDC"}],"standard_charges":[{"gross_charge":459.97,"discounted_cash":114.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"49319028","type":"NDC"}],"standard_charges":[{"gross_charge":434.86,"discounted_cash":108.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"72266013101","type":"NDC"}],"standard_charges":[{"gross_charge":89.55,"discounted_cash":22.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"70436002980","type":"NDC"}],"standard_charges":[{"gross_charge":116.82,"discounted_cash":29.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"49419001","type":"NDC"}],"standard_charges":[{"gross_charge":213.87,"discounted_cash":53.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"voriconazole per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3465","type":"HCPCS"},{"code":"781341694","type":"NDC"}],"standard_charges":[{"gross_charge":125.85,"discounted_cash":31.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323028010","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323028004","type":"NDC"}],"standard_charges":[{"gross_charge":8.99,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323028002","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143915701","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143915610","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288020311","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"69367019050","type":"NDC"}],"standard_charges":[{"gross_charge":317.66,"discounted_cash":79.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"78038725","type":"NDC"}],"standard_charges":[{"gross_charge":6558.11,"discounted_cash":1639.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol lactate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"25021080601","type":"NDC"}],"standard_charges":[{"gross_charge":14.86,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"39822180001","type":"NDC"}],"standard_charges":[{"gross_charge":92.76,"discounted_cash":23.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"31722030801","type":"NDC"}],"standard_charges":[{"gross_charge":151.82,"discounted_cash":37.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150030801","type":"NDC"}],"standard_charges":[{"gross_charge":140.64,"discounted_cash":35.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"781910572","type":"NDC"}],"standard_charges":[{"gross_charge":160.4,"discounted_cash":40.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"517095501","type":"NDC"}],"standard_charges":[{"gross_charge":142.78,"discounted_cash":35.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"781315972","type":"NDC"}],"standard_charges":[{"gross_charge":384.99,"discounted_cash":96.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZapine 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"2759701","type":"NDC"}],"standard_charges":[{"gross_charge":364.39,"discounted_cash":91.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cetuximab per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733094823","type":"NDC"}],"standard_charges":[{"gross_charge":6065.57,"discounted_cash":1516.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"71288016750","type":"NDC"}],"standard_charges":[{"gross_charge":475.15,"discounted_cash":118.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"70860020350","type":"NDC"}],"standard_charges":[{"gross_charge":308.32,"discounted_cash":77.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"63323045050","type":"NDC"}],"standard_charges":[{"gross_charge":343.09,"discounted_cash":85.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"55150038201","type":"NDC"}],"standard_charges":[{"gross_charge":652.56,"discounted_cash":163.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"50742034101","type":"NDC"}],"standard_charges":[{"gross_charge":1578.57,"discounted_cash":394.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"43598038711","type":"NDC"}],"standard_charges":[{"gross_charge":543.78,"discounted_cash":135.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9296","type":"HCPCS"},{"code":"16729023011","type":"NDC"}],"standard_charges":[{"gross_charge":424.21,"discounted_cash":106.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019095601","type":"NDC"}],"standard_charges":[{"gross_charge":2137.68,"discounted_cash":534.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"2762301","type":"NDC"}],"standard_charges":[{"gross_charge":30195.18,"discounted_cash":7548.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019095616","type":"NDC"}],"standard_charges":[{"gross_charge":2137.68,"discounted_cash":534.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019094450","type":"NDC"}],"standard_charges":[{"gross_charge":2502.45,"discounted_cash":625.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019094501","type":"NDC"}],"standard_charges":[{"gross_charge":5004.89,"discounted_cash":1251.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019095711","type":"NDC"}],"standard_charges":[{"gross_charge":4061.56,"discounted_cash":1015.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019095701","type":"NDC"}],"standard_charges":[{"gross_charge":4061.56,"discounted_cash":1015.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"39822025001","type":"NDC"}],"standard_charges":[{"gross_charge":357.19,"discounted_cash":89.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"70121123801","type":"NDC"}],"standard_charges":[{"gross_charge":574.19,"discounted_cash":143.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"781323394","type":"NDC"}],"standard_charges":[{"gross_charge":507.55,"discounted_cash":126.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019094325","type":"NDC"}],"standard_charges":[{"gross_charge":1932.92,"discounted_cash":483.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019094301","type":"NDC"}],"standard_charges":[{"gross_charge":1251.26,"discounted_cash":312.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019095550","type":"NDC"}],"standard_charges":[{"gross_charge":1068.8,"discounted_cash":267.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019095501","type":"NDC"}],"standard_charges":[{"gross_charge":1068.8,"discounted_cash":267.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"25021024851","type":"NDC"}],"standard_charges":[{"gross_charge":843.21,"discounted_cash":210.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"39822025501","type":"NDC"}],"standard_charges":[{"gross_charge":725.02,"discounted_cash":181.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"81298811201","type":"NDC"}],"standard_charges":[{"gross_charge":672.39,"discounted_cash":168.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"70121123901","type":"NDC"}],"standard_charges":[{"gross_charge":1016.64,"discounted_cash":254.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"781324494","type":"NDC"}],"standard_charges":[{"gross_charge":942.56,"discounted_cash":235.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019094401","type":"NDC"}],"standard_charges":[{"gross_charge":2502.45,"discounted_cash":625.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"409336511","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE microspheres per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030811","type":"NDC"}],"standard_charges":[{"gross_charge":8600.04,"discounted_cash":2150.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE microspheres per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030711","type":"NDC"}],"standard_charges":[{"gross_charge":6449.8,"discounted_cash":1612.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"palonosetron per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"55150018605","type":"NDC"}],"standard_charges":[{"gross_charge":65.72,"discounted_cash":16.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"palonosetron per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"67457031725","type":"NDC"}],"standard_charges":[{"gross_charge":90.23,"discounted_cash":22.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"palonosetron per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"60505619301","type":"NDC"}],"standard_charges":[{"gross_charge":173.96,"discounted_cash":43.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"palonosetron per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"25021078305","type":"NDC"}],"standard_charges":[{"gross_charge":105.1,"discounted_cash":26.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"palonosetron per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"703409401","type":"NDC"}],"standard_charges":[{"gross_charge":32.33,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"palonosetron per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"55111069407","type":"NDC"}],"standard_charges":[{"gross_charge":44.2,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"palonosetron per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"16729036566","type":"NDC"}],"standard_charges":[{"gross_charge":384.69,"discounted_cash":96.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"palonosetron per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"62856079701","type":"NDC"}],"standard_charges":[{"gross_charge":602.84,"discounted_cash":150.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.45% with KCL 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"990925739","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.45% with KCL 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338070434","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol lactate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"gross_charge":40.84,"discounted_cash":10.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol lactate per 5 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"143931925","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol lactate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"143931901","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol lactate per 5 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"63323047400","type":"NDC"}],"standard_charges":[{"gross_charge":8.17,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol lactate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"67457042600","type":"NDC"}],"standard_charges":[{"gross_charge":4.89,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"palonosetron per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"63323067305","type":"NDC"}],"standard_charges":[{"gross_charge":352.44,"discounted_cash":88.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"517090125","type":"NDC"}],"standard_charges":[{"gross_charge":105.29,"discounted_cash":26.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"17478093415","type":"NDC"}],"standard_charges":[{"gross_charge":288.31,"discounted_cash":72.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323061416","type":"NDC"}],"standard_charges":[{"gross_charge":24.16,"discounted_cash":6.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE microspheres per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458030601","type":"NDC"}],"standard_charges":[{"gross_charge":4299.71,"discounted_cash":1074.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"daptomycin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"31722021601","type":"NDC"}],"standard_charges":[{"gross_charge":139.41,"discounted_cash":34.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"daptomycin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0877","type":"HCPCS"},{"code":"409012201","type":"NDC"}],"standard_charges":[{"gross_charge":257.38,"discounted_cash":64.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"daptomycin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"gross_charge":115.97,"discounted_cash":28.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"daptomycin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"gross_charge":539.42,"discounted_cash":134.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"daptomycin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"67457081350","type":"NDC"}],"standard_charges":[{"gross_charge":82.8,"discounted_cash":20.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"daptomycin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"67919001202","type":"NDC"}],"standard_charges":[{"gross_charge":269.1,"discounted_cash":67.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021031102","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"gross_charge":145.39,"discounted_cash":36.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"55150040001","type":"NDC"}],"standard_charges":[{"gross_charge":22.69,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"641623125","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"641623101","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"517090101","type":"NDC"}],"standard_charges":[{"gross_charge":105.29,"discounted_cash":26.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323061400","type":"NDC"}],"standard_charges":[{"gross_charge":130.55,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"67457029101","type":"NDC"}],"standard_charges":[{"gross_charge":22.18,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"67457029100","type":"NDC"}],"standard_charges":[{"gross_charge":22.18,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrALAZINE per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"55150040025","type":"NDC"}],"standard_charges":[{"gross_charge":22.69,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"64679075911","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"64679075902","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150032425","type":"NDC"}],"standard_charges":[{"gross_charge":2.91,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium acetate(phosphat bind) 667 mg capsule 200 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0615","type":"HCPCS"},{"code":"62135019122","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium acetate(phosphat bind) 667 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0615","type":"HCPCS"},{"code":"68084047911","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium acetate(phosphat bind) 667 mg capsule 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0615","type":"HCPCS"},{"code":"54008813","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium acetate(phosphat bind) 667 mg capsule 200 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0615","type":"HCPCS"},{"code":"781208102","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL citrate (PF)-0.9%NaCl 10 mcg/mL solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"97710516103","type":"NDC"}],"standard_charges":[{"gross_charge":128.31,"discounted_cash":32.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL citrate (PF)-0.9%NaCl 10 mcg/mL solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"70092109337","type":"NDC"}],"standard_charges":[{"gross_charge":212.57,"discounted_cash":53.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080650","type":"NDC"}],"standard_charges":[{"gross_charge":191.5,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080620","type":"NDC"}],"standard_charges":[{"gross_charge":108.93,"discounted_cash":27.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080614","type":"NDC"}],"standard_charges":[{"gross_charge":108.93,"discounted_cash":27.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080612","type":"NDC"}],"standard_charges":[{"gross_charge":17.54,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080602","type":"NDC"}],"standard_charges":[{"gross_charge":17.54,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909417","type":"NDC"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909416","type":"NDC"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909345","type":"NDC"}],"standard_charges":[{"gross_charge":7.47,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909418","type":"NDC"}],"standard_charges":[{"gross_charge":7.81,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium acetate(phosphat bind) 667 mg capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0615","type":"HCPCS"},{"code":"904711906","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909337","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium acetate(phosphat bind) 667 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0615","type":"HCPCS"},{"code":"904711961","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"61703034222","type":"NDC"}],"standard_charges":[{"gross_charge":202.63,"discounted_cash":50.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"47781059507","type":"NDC"}],"standard_charges":[{"gross_charge":420.92,"discounted_cash":105.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"70860020050","type":"NDC"}],"standard_charges":[{"gross_charge":356.96,"discounted_cash":89.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"70860020017","type":"NDC"}],"standard_charges":[{"gross_charge":178.45,"discounted_cash":44.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"70860020005","type":"NDC"}],"standard_charges":[{"gross_charge":53.54,"discounted_cash":13.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"703476881","type":"NDC"}],"standard_charges":[{"gross_charge":233.63,"discounted_cash":58.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"67457047152","type":"NDC"}],"standard_charges":[{"gross_charge":55.61,"discounted_cash":13.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"67457043451","type":"NDC"}],"standard_charges":[{"gross_charge":242.82,"discounted_cash":60.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"45963061359","type":"NDC"}],"standard_charges":[{"gross_charge":234.01,"discounted_cash":58.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"45963061356","type":"NDC"}],"standard_charges":[{"gross_charge":53.7,"discounted_cash":13.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"44567050601","type":"NDC"}],"standard_charges":[{"gross_charge":400.24,"discounted_cash":100.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.002,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"25021021305","type":"NDC"}],"standard_charges":[{"gross_charge":66.39,"discounted_cash":16.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"703476801","type":"NDC"}],"standard_charges":[{"gross_charge":233.63,"discounted_cash":58.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"63323076350","type":"NDC"}],"standard_charges":[{"gross_charge":1238.24,"discounted_cash":309.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"703476601","type":"NDC"}],"standard_charges":[{"gross_charge":92.36,"discounted_cash":23.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"61703034250","type":"NDC"}],"standard_charges":[{"gross_charge":515.14,"discounted_cash":128.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"61703034209","type":"NDC"}],"standard_charges":[{"gross_charge":65.72,"discounted_cash":16.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909441","type":"NDC"}],"standard_charges":[{"gross_charge":83.49,"discounted_cash":20.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909412","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"641602501","type":"NDC"}],"standard_charges":[{"gross_charge":21.14,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"97710501701","type":"NDC"}],"standard_charges":[{"gross_charge":371.66,"discounted_cash":92.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"641602010","type":"NDC"}],"standard_charges":[{"gross_charge":377.94,"discounted_cash":94.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"641602001","type":"NDC"}],"standard_charges":[{"gross_charge":377.94,"discounted_cash":94.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"409381412","type":"NDC"}],"standard_charges":[{"gross_charge":138.03,"discounted_cash":34.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bivalirudin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"83634040041","type":"NDC"}],"standard_charges":[{"gross_charge":417.77,"discounted_cash":104.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bivalirudin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"83634040010","type":"NDC"}],"standard_charges":[{"gross_charge":417.77,"discounted_cash":104.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bivalirudin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"71288042710","type":"NDC"}],"standard_charges":[{"gross_charge":290.01,"discounted_cash":72.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bivalirudin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"55150021010","type":"NDC"}],"standard_charges":[{"gross_charge":344.39,"discounted_cash":86.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bivalirudin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"63323056241","type":"NDC"}],"standard_charges":[{"gross_charge":702.5,"discounted_cash":175.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bivalirudin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"55111065237","type":"NDC"}],"standard_charges":[{"gross_charge":351.63,"discounted_cash":87.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bivalirudin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"55111065207","type":"NDC"}],"standard_charges":[{"gross_charge":351.63,"discounted_cash":87.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bivalirudin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"63323056210","type":"NDC"}],"standard_charges":[{"gross_charge":3724.96,"discounted_cash":931.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bivalirudin per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"781315895","type":"NDC"}],"standard_charges":[{"gross_charge":1520.13,"discounted_cash":380.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranolol per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1800","type":"HCPCS"},{"code":"63323060401","type":"NDC"}],"standard_charges":[{"gross_charge":71.71,"discounted_cash":17.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranolol per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1800","type":"HCPCS"},{"code":"143987201","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"409381411","type":"NDC"}],"standard_charges":[{"gross_charge":138.03,"discounted_cash":34.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"10019067010","type":"NDC"}],"standard_charges":[{"gross_charge":984.31,"discounted_cash":246.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"67457065725","type":"NDC"}],"standard_charges":[{"gross_charge":616.63,"discounted_cash":154.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021030884","type":"NDC"}],"standard_charges":[{"gross_charge":478.75,"discounted_cash":119.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"641603001","type":"NDC"}],"standard_charges":[{"gross_charge":121.79,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"641602901","type":"NDC"}],"standard_charges":[{"gross_charge":55.76,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"641602825","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"641602801","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"641602701","type":"NDC"}],"standard_charges":[{"gross_charge":11.14,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"641602601","type":"NDC"}],"standard_charges":[{"gross_charge":74.91,"discounted_cash":18.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"641602401","type":"NDC"}],"standard_charges":[{"gross_charge":14.09,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"45963061386","type":"NDC"}],"standard_charges":[{"gross_charge":53.7,"discounted_cash":13.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"17478003005","type":"NDC"}],"standard_charges":[{"gross_charge":16.12,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909428","type":"NDC"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909461","type":"NDC"}],"standard_charges":[{"gross_charge":83.49,"discounted_cash":20.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF 50 mcg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909422","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909335","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909332","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"409909431","type":"NDC"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"10019005561","type":"NDC"}],"standard_charges":[{"gross_charge":825.37,"discounted_cash":206.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL PF per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"17478003002","type":"NDC"}],"standard_charges":[{"gross_charge":12.61,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"10019094510","type":"NDC"}],"standard_charges":[{"gross_charge":7747.86,"discounted_cash":1936.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"703321601","type":"NDC"}],"standard_charges":[{"gross_charge":118.58,"discounted_cash":29.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"703321801","type":"NDC"}],"standard_charges":[{"gross_charge":299.51,"discounted_cash":74.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"23155047333","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"23155047332","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"23155047331","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409610210","type":"NDC"}],"standard_charges":[{"gross_charge":7.83,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409610204","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409610202","type":"NDC"}],"standard_charges":[{"gross_charge":23.49,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5 mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935075680","type":"NDC"}],"standard_charges":[{"gross_charge":3451.29,"discounted_cash":862.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5 mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935075474","type":"NDC"}],"standard_charges":[{"gross_charge":3448.53,"discounted_cash":862.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5 mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935075375","type":"NDC"}],"standard_charges":[{"gross_charge":3448.53,"discounted_cash":862.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pamidronate per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"67457044610","type":"NDC"}],"standard_charges":[{"gross_charge":215.32,"discounted_cash":53.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pamidronate per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703032618","type":"NDC"}],"standard_charges":[{"gross_charge":271.39,"discounted_cash":67.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"botulinum toxin Type A (Cosm) per 1 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0585","type":"HCPCS"},{"code":"23114501","type":"NDC"}],"standard_charges":[{"gross_charge":4948.36,"discounted_cash":1237.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pamidronate per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"67457043010","type":"NDC"}],"standard_charges":[{"gross_charge":67.41,"discounted_cash":16.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pamidronate per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703032418","type":"NDC"}],"standard_charges":[{"gross_charge":104.33,"discounted_cash":26.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 5 mg/mL solution 10 mL Vial","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323018410","type":"NDC"}],"standard_charges":[{"gross_charge":3.34,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"23155047341","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"folic acid 5 mg/mL solution 10 mL Vial","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150032401","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150032325","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150032301","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150032225","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150032201","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323028005","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323028003","type":"NDC"}],"standard_charges":[{"gross_charge":8.99,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323028001","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409610220","type":"NDC"}],"standard_charges":[{"gross_charge":7.83,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409610219","type":"NDC"}],"standard_charges":[{"gross_charge":23.49,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409610218","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323028036","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323028026","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323028016","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"36000028425","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"furosemide per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, pegfilgrastim, excludes biosimilar, 0.5 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"gross_charge":16057.28,"discounted_cash":4014.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457058210","type":"NDC"}],"standard_charges":[{"gross_charge":180.89,"discounted_cash":45.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457058200","type":"NDC"}],"standard_charges":[{"gross_charge":36.05,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041182","type":"NDC"}],"standard_charges":[{"gross_charge":61.47,"discounted_cash":15.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75802501","type":"NDC"}],"standard_charges":[{"gross_charge":91.15,"discounted_cash":22.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"anakinra 100 mg/0.67 mL syringe 0.67 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"66658023407","type":"NDC"}],"standard_charges":[{"gross_charge":1609.8,"discounted_cash":402.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"anakinra 100 mg/0.67 mL syringe 0.67 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"66658023401","type":"NDC"}],"standard_charges":[{"gross_charge":1609.8,"discounted_cash":402.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"floxuridine per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9200","type":"HCPCS"},{"code":"63323014507","type":"NDC"}],"standard_charges":[{"gross_charge":710.39,"discounted_cash":177.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin immune fab per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1162","type":"HCPCS"},{"code":"50633012111","type":"NDC"}],"standard_charges":[{"gross_charge":34677.66,"discounted_cash":8669.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin immune fab per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1162","type":"HCPCS"},{"code":"50633012011","type":"NDC"}],"standard_charges":[{"gross_charge":34677.66,"discounted_cash":8669.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alteplase per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"gross_charge":1342.49,"discounted_cash":335.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alteplase per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004163","type":"NDC"}],"standard_charges":[{"gross_charge":1086.26,"discounted_cash":271.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"23155088431","type":"NDC"}],"standard_charges":[{"gross_charge":342.79,"discounted_cash":85.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"23155088331","type":"NDC"}],"standard_charges":[{"gross_charge":147.62,"discounted_cash":36.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"72205006301","type":"NDC"}],"standard_charges":[{"gross_charge":314.83,"discounted_cash":78.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"703321381","type":"NDC"}],"standard_charges":[{"gross_charge":53.85,"discounted_cash":13.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"703321301","type":"NDC"}],"standard_charges":[{"gross_charge":57.83,"discounted_cash":14.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"703321881","type":"NDC"}],"standard_charges":[{"gross_charge":234.4,"discounted_cash":58.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041183","type":"NDC"}],"standard_charges":[{"gross_charge":61.47,"discounted_cash":15.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75291500","type":"NDC"}],"standard_charges":[{"gross_charge":266.05,"discounted_cash":66.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043895","type":"NDC"}],"standard_charges":[{"gross_charge":61.47,"discounted_cash":15.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043896","type":"NDC"}],"standard_charges":[{"gross_charge":61.47,"discounted_cash":15.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111067811","type":"NDC"}],"standard_charges":[{"gross_charge":68.17,"discounted_cash":17.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111067802","type":"NDC"}],"standard_charges":[{"gross_charge":68.17,"discounted_cash":17.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"43598090158","type":"NDC"}],"standard_charges":[{"gross_charge":232.01,"discounted_cash":58.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"43598090111","type":"NDC"}],"standard_charges":[{"gross_charge":232.01,"discounted_cash":58.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"44567082001","type":"NDC"}],"standard_charges":[{"gross_charge":125.72,"discounted_cash":31.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"gross_charge":170.19,"discounted_cash":42.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"gross_charge":170.19,"discounted_cash":42.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"703321681","type":"NDC"}],"standard_charges":[{"gross_charge":92.74,"discounted_cash":23.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022189","type":"NDC"}],"standard_charges":[{"gross_charge":388.45,"discounted_cash":97.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"gross_charge":362.51,"discounted_cash":90.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022101","type":"NDC"}],"standard_charges":[{"gross_charge":362.51,"discounted_cash":90.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"gross_charge":163.86,"discounted_cash":40.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"6384371","type":"NDC"}],"standard_charges":[{"gross_charge":917.24,"discounted_cash":229.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75291501","type":"NDC"}],"standard_charges":[{"gross_charge":266.05,"discounted_cash":66.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043894","type":"NDC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043893","type":"NDC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ertapenem per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022185","type":"NDC"}],"standard_charges":[{"gross_charge":388.45,"discounted_cash":97.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"781325594","type":"NDC"}],"standard_charges":[{"gross_charge":1631.27,"discounted_cash":407.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"70121124001","type":"NDC"}],"standard_charges":[{"gross_charge":2320.06,"discounted_cash":580.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"81298811401","type":"NDC"}],"standard_charges":[{"gross_charge":1450.04,"discounted_cash":362.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505623100","type":"NDC"}],"standard_charges":[{"gross_charge":31.02,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tenecteplase per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242012047","type":"NDC"}],"standard_charges":[{"gross_charge":59076.22,"discounted_cash":14769.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tenecteplase per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242003706","type":"NDC"}],"standard_charges":[{"gross_charge":59076.22,"discounted_cash":14769.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"97710515201","type":"NDC"}],"standard_charges":[{"gross_charge":37.53,"discounted_cash":9.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"97710510002","type":"NDC"}],"standard_charges":[{"gross_charge":54.39,"discounted_cash":13.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"338358101","type":"NDC"}],"standard_charges":[{"gross_charge":66.64,"discounted_cash":16.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem in sodium chloride 1 gram/50 mL piggyback 1 each Flex Cont","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2184","type":"HCPCS"},{"code":"264318511","type":"NDC"}],"standard_charges":[{"gross_charge":193.05,"discounted_cash":48.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in 5 % dex per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323052201","type":"NDC"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":22.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in 5 % dex per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323052277","type":"NDC"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":22.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in 5 % dex per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"264957710","type":"NDC"}],"standard_charges":[{"gross_charge":114.9,"discounted_cash":28.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"gross_charge":31.02,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567084001","type":"NDC"}],"standard_charges":[{"gross_charge":37.38,"discounted_cash":9.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021011382","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"},{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"papaverine per 60 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"517400225","type":"NDC"}],"standard_charges":[{"gross_charge":244.11,"discounted_cash":61.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054001","type":"NDC"}],"standard_charges":[{"gross_charge":13.08,"discounted_cash":3.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"409272031","type":"NDC"}],"standard_charges":[{"gross_charge":17.77,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1643","type":"HCPCS"},{"code":"69013701","type":"NDC"}],"standard_charges":[{"gross_charge":45.04,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040010","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040001","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, nitroglycerin, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338104702","type":"NDC"}],"standard_charges":[{"gross_charge":116.82,"discounted_cash":29.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine per 1 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"97710507701","type":"NDC"}],"standard_charges":[{"gross_charge":25.67,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole per 200 mg","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"97710507501","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"remdesivir 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0248","type":"HCPCS"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"gross_charge":4850.77,"discounted_cash":1212.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole/NS 800 mg piggyback 200 mL Flex Cont","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"36000000310","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":10.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole/NS 800 mg piggyback 200 mL Flex Cont","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"36000000306","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":10.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole/NS 800 mg piggyback 200 mL Flex Cont","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021011387","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":10.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 mL Flex Cont","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"36000000210","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 mL Flex Cont","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567084025","type":"NDC"}],"standard_charges":[{"gross_charge":37.38,"discounted_cash":9.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine in 5 % dextrose per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"97710514701","type":"NDC"}],"standard_charges":[{"gross_charge":9.19,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine in 5 % dextrose per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"97710514601","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478042020","type":"NDC"}],"standard_charges":[{"gross_charge":162.09,"discounted_cash":40.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) PF per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"97710515901","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 25 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"66794016202","type":"NDC"}],"standard_charges":[{"gross_charge":2391.76,"discounted_cash":597.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 25 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409113502","type":"NDC"}],"standard_charges":[{"gross_charge":50.56,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"43825010201","type":"NDC"}],"standard_charges":[{"gross_charge":337.81,"discounted_cash":84.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"72819015404","type":"NDC"}],"standard_charges":[{"gross_charge":1050.34,"discounted_cash":262.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"71288013951","type":"NDC"}],"standard_charges":[{"gross_charge":1908.18,"discounted_cash":477.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"67457099740","type":"NDC"}],"standard_charges":[{"gross_charge":11134.19,"discounted_cash":2783.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"143928001","type":"NDC"}],"standard_charges":[{"gross_charge":9466.84,"discounted_cash":2366.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"67457052040","type":"NDC"}],"standard_charges":[{"gross_charge":21741.76,"discounted_cash":5435.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"16729011638","type":"NDC"}],"standard_charges":[{"gross_charge":10870.69,"discounted_cash":2717.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"65219036802","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"65219036801","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"97710517601","type":"NDC"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409233934","type":"NDC"}],"standard_charges":[{"gross_charge":65.63,"discounted_cash":16.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409226720","type":"NDC"}],"standard_charges":[{"gross_charge":26.35,"discounted_cash":6.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143962201","type":"NDC"}],"standard_charges":[{"gross_charge":66.64,"discounted_cash":16.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47781058629","type":"NDC"}],"standard_charges":[{"gross_charge":15.78,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine in 0.9% sodium chloride 100 mg/100 mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"97710518202","type":"NDC"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":22.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine in 0.9% sodium chloride 100 mg/100 mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092138036","type":"NDC"}],"standard_charges":[{"gross_charge":65.11,"discounted_cash":16.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine in 0.9% sodium chloride 100 mg/100 mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092113036","type":"NDC"}],"standard_charges":[{"gross_charge":104.94,"discounted_cash":26.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylnaltrexone per 0.1 mg","drug_information":{"unit":0.66667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055107","type":"NDC"}],"standard_charges":[{"gross_charge":821.31,"discounted_cash":205.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylnaltrexone per 0.1 mg","drug_information":{"unit":0.66667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055103","type":"NDC"}],"standard_charges":[{"gross_charge":821.34,"discounted_cash":205.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylnaltrexone per 0.1 mg","drug_information":{"unit":0.66667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055102","type":"NDC"}],"standard_charges":[{"gross_charge":821.31,"discounted_cash":205.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143918301","type":"NDC"}],"standard_charges":[{"gross_charge":36.46,"discounted_cash":9.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 10 mg/mL (1 %) solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427601","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65145012401","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"36000032201","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"36000032010","type":"NDC"}],"standard_charges":[{"gross_charge":25.37,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"36000032001","type":"NDC"}],"standard_charges":[{"gross_charge":25.37,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72266010201","type":"NDC"}],"standard_charges":[{"gross_charge":14.55,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409233924","type":"NDC"}],"standard_charges":[{"gross_charge":65.63,"discounted_cash":16.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143932001","type":"NDC"}],"standard_charges":[{"gross_charge":16.39,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47781058656","type":"NDC"}],"standard_charges":[{"gross_charge":33.4,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, labetalol hydrochloride, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"36000032202","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"409677811","type":"NDC"}],"standard_charges":[{"gross_charge":6.27,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 10 mg/mL (1 %) solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427602","type":"NDC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"61703040841","type":"NDC"}],"standard_charges":[{"gross_charge":273.92,"discounted_cash":68.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155060031","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641605701","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"17478052355","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"17478052305","type":"NDC"}],"standard_charges":[{"gross_charge":2.28,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"25021065502","type":"NDC"}],"standard_charges":[{"gross_charge":0.87,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641605910","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641605901","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641605601","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409258705","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meperidine (PF) per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"409117603","type":"NDC"}],"standard_charges":[{"gross_charge":43.57,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meperidine (PF) per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"641605225","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meperidine (PF) per 100 mg","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"641605201","type":"NDC"}],"standard_charges":[{"gross_charge":66.21,"discounted_cash":16.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meperidine (PF) per 100 mg","drug_information":{"unit":4.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"409117630","type":"NDC"}],"standard_charges":[{"gross_charge":174.28,"discounted_cash":43.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155060041","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"47781058846","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641620901","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918070002","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918070025","type":"NDC"}],"standard_charges":[{"gross_charge":53.47,"discounted_cash":13.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918070001","type":"NDC"}],"standard_charges":[{"gross_charge":53.47,"discounted_cash":13.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70710137702","type":"NDC"}],"standard_charges":[{"gross_charge":94.22,"discounted_cash":23.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70710137701","type":"NDC"}],"standard_charges":[{"gross_charge":94.22,"discounted_cash":23.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69374091910","type":"NDC"}],"standard_charges":[{"gross_charge":137.88,"discounted_cash":34.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"409662902","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041112","type":"NDC"}],"standard_charges":[{"gross_charge":6.07,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041110","type":"NDC"}],"standard_charges":[{"gross_charge":6.73,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"72611074125","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"72611074101","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409258704","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70860060041","type":"NDC"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041115","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641620925","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"47781058868","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040266","type":"NDC"}],"standard_charges":[{"gross_charge":22.34,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040201","type":"NDC"}],"standard_charges":[{"gross_charge":6.26,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676030201","type":"NDC"}],"standard_charges":[{"gross_charge":380.41,"discounted_cash":95.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF 10 mg/mL (1 %) elastomeric pump,fixed rate 5 mL Vial","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143959525","type":"NDC"}],"standard_charges":[{"gross_charge":173.88,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF 10 mg/mL (1 %) elastomeric pump,fixed rate 5 mL Vial","drug_information":{"unit":20.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143959501","type":"NDC"}],"standard_charges":[{"gross_charge":173.88,"discounted_cash":43.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF 10 mg/mL (1 %) elastomeric pump,fixed rate 30 mL Vial","drug_information":{"unit":3.33333,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049237","type":"NDC"}],"standard_charges":[{"gross_charge":284.95,"discounted_cash":71.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF 10 mg/mL (1 %) elastomeric pump,fixed rate 30 mL Vial","drug_information":{"unit":3.33333,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427902","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"97710517202","type":"NDC"}],"standard_charges":[{"gross_charge":234.4,"discounted_cash":58.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methacholine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"97710300302","type":"NDC"}],"standard_charges":[{"gross_charge":556.08,"discounted_cash":139.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone in 0.9 % NaCl per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"97710501301","type":"NDC"}],"standard_charges":[{"gross_charge":57.83,"discounted_cash":14.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"143951910","type":"NDC"}],"standard_charges":[{"gross_charge":24.83,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"143951901","type":"NDC"}],"standard_charges":[{"gross_charge":24.83,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"703367881","type":"NDC"}],"standard_charges":[{"gross_charge":125.32,"discounted_cash":31.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"16729027735","type":"NDC"}],"standard_charges":[{"gross_charge":150.14,"discounted_cash":37.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"703367801","type":"NDC"}],"standard_charges":[{"gross_charge":199.77,"discounted_cash":49.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"703367501","type":"NDC"}],"standard_charges":[{"gross_charge":29.03,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"703367101","type":"NDC"}],"standard_charges":[{"gross_charge":75.3,"discounted_cash":18.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexAMETHasone 4 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"67457042300","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexAMETHasone 4 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"76329191101","type":"NDC"}],"standard_charges":[{"gross_charge":71.24,"discounted_cash":17.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"61553069668","type":"NDC"}],"standard_charges":[{"gross_charge":50.33,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"insulin aspart for insulin pump per 50 Units","drug_information":{"unit":5.0,"type":"UN"},"code_information":[{"code":"636","type":"RC"},{"code":"J1817","type":"HCPCS"},{"code":"97710511601","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"5446141601","type":"NDC"}],"standard_charges":[{"gross_charge":3830.0,"discounted_cash":957.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"97710222501","type":"NDC"}],"standard_charges":[{"gross_charge":9.88,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentanyl per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"61553067176","type":"NDC"}],"standard_charges":[{"gross_charge":141.14,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"97710506001","type":"NDC"}],"standard_charges":[{"gross_charge":72.62,"discounted_cash":18.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092151948","type":"NDC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"crotalidae polyvalent immune fab per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0840","type":"HCPCS"},{"code":"50633011012","type":"NDC"}],"standard_charges":[{"gross_charge":24435.44,"discounted_cash":6108.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"409677815","type":"NDC"}],"standard_charges":[{"gross_charge":6.27,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"641620725","type":"NDC"}],"standard_charges":[{"gross_charge":0.88,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution 250 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"409798325","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004948","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004941","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"338004904","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"338004903","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004902","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"338630403","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 250 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"264780020","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride amnioinfusion per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"264780000","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride amnioinfusion per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"264180032","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride amnioinfusion per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"264180031","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323030601","type":"NDC"}],"standard_charges":[{"gross_charge":50.13,"discounted_cash":12.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"409357811","type":"NDC"}],"standard_charges":[{"gross_charge":20.97,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323030626","type":"NDC"}],"standard_charges":[{"gross_charge":9.97,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"36000024201","type":"NDC"}],"standard_charges":[{"gross_charge":79.74,"discounted_cash":19.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"264151031","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457047300","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"264151032","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"264751020","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated ringers amnioinfusion solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"338011704","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated ringers amnioinfusion solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"338011703","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"60739000","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338008504","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338008503","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.9 % per 500 mL","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338008904","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.9 % per 500 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338008903","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"97710522403","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"409792225","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"338001704","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"338001703","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"338001702","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"264751010","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"409357801","type":"NDC"}],"standard_charges":[{"gross_charge":20.97,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"gross_charge":50.13,"discounted_cash":12.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"60505628207","type":"NDC"}],"standard_charges":[{"gross_charge":298.28,"discounted_cash":74.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033956","type":"NDC"}],"standard_charges":[{"gross_charge":428.35,"discounted_cash":107.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033950","type":"NDC"}],"standard_charges":[{"gross_charge":341.25,"discounted_cash":85.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033922","type":"NDC"}],"standard_charges":[{"gross_charge":168.1,"discounted_cash":42.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033918","type":"NDC"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":24.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"25021031802","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457085500","type":"NDC"}],"standard_charges":[{"gross_charge":5.92,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"17478054202","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"25021030102","type":"NDC"}],"standard_charges":[{"gross_charge":26.43,"discounted_cash":6.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323065102","type":"NDC"}],"standard_charges":[{"gross_charge":50.71,"discounted_cash":12.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine per 100 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"63323096321","type":"NDC"}],"standard_charges":[{"gross_charge":19.1,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine per 100 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"55150025930","type":"NDC"}],"standard_charges":[{"gross_charge":23.55,"discounted_cash":5.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine per 100 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"63323096330","type":"NDC"}],"standard_charges":[{"gross_charge":19.1,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine per 100 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"574080530","type":"NDC"}],"standard_charges":[{"gross_charge":104.42,"discounted_cash":26.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetylcysteine per 100 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"66220020730","type":"NDC"}],"standard_charges":[{"gross_charge":17.72,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclophosphamide per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9075","type":"HCPCS"},{"code":"39822026001","type":"NDC"}],"standard_charges":[{"gross_charge":751.91,"discounted_cash":187.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"703424801","type":"NDC"}],"standard_charges":[{"gross_charge":379.86,"discounted_cash":94.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"63323017260","type":"NDC"}],"standard_charges":[{"gross_charge":1025.37,"discounted_cash":256.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"703424401","type":"NDC"}],"standard_charges":[{"gross_charge":44.12,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"703424601","type":"NDC"}],"standard_charges":[{"gross_charge":153.39,"discounted_cash":38.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"60505628203","type":"NDC"}],"standard_charges":[{"gross_charge":287.36,"discounted_cash":71.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"54288016701","type":"NDC"}],"standard_charges":[{"gross_charge":384.23,"discounted_cash":96.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"54288016401","type":"NDC"}],"standard_charges":[{"gross_charge":58.37,"discounted_cash":14.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703060005","type":"NDC"}],"standard_charges":[{"gross_charge":453.17,"discounted_cash":113.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"55150038601","type":"NDC"}],"standard_charges":[{"gross_charge":210.96,"discounted_cash":52.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"55150033501","type":"NDC"}],"standard_charges":[{"gross_charge":140.64,"discounted_cash":35.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"50742044745","type":"NDC"}],"standard_charges":[{"gross_charge":631.84,"discounted_cash":157.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729029534","type":"NDC"}],"standard_charges":[{"gross_charge":212.68,"discounted_cash":53.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729029531","type":"NDC"}],"standard_charges":[{"gross_charge":28.19,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729029512","type":"NDC"}],"standard_charges":[{"gross_charge":301.5,"discounted_cash":75.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"703423981","type":"NDC"}],"standard_charges":[{"gross_charge":207.28,"discounted_cash":51.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"703424481","type":"NDC"}],"standard_charges":[{"gross_charge":33.63,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"703424881","type":"NDC"}],"standard_charges":[{"gross_charge":165.8,"discounted_cash":41.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"703424681","type":"NDC"}],"standard_charges":[{"gross_charge":62.28,"discounted_cash":15.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"703423901","type":"NDC"}],"standard_charges":[{"gross_charge":1025.37,"discounted_cash":256.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOplatin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729029533","type":"NDC"}],"standard_charges":[{"gross_charge":196.13,"discounted_cash":49.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"409677805","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457037499","type":"NDC"}],"standard_charges":[{"gross_charge":21.68,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457037412","type":"NDC"}],"standard_charges":[{"gross_charge":21.68,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"409272302","type":"NDC"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1643","type":"HCPCS"},{"code":"409272301","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323026201","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042296","type":"NDC"}],"standard_charges":[{"gross_charge":6.77,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042295","type":"NDC"}],"standard_charges":[{"gross_charge":6.77,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040302","type":"NDC"}],"standard_charges":[{"gross_charge":12.79,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040301","type":"NDC"}],"standard_charges":[{"gross_charge":12.79,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457094901","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457094900","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1643","type":"HCPCS"},{"code":"409272330","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"641620701","type":"NDC"}],"standard_charges":[{"gross_charge":3.51,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"76329826100","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"76329826101","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"641604601","type":"NDC"}],"standard_charges":[{"gross_charge":10.93,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"641604425","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"641604401","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"641600125","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"641600101","type":"NDC"}],"standard_charges":[{"gross_charge":13.79,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"409677802","type":"NDC"}],"standard_charges":[{"gross_charge":6.27,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"409678002","type":"NDC"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"409198530","type":"NDC"}],"standard_charges":[{"gross_charge":25.88,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lORazepam per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"17478004001","type":"NDC"}],"standard_charges":[{"gross_charge":31.11,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"409477723","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":4.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide (6 month) per 7.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935046150","type":"NDC"}],"standard_charges":[{"gross_charge":20707.66,"discounted_cash":5176.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide (6 month) per 7.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935045444","type":"NDC"}],"standard_charges":[{"gross_charge":20691.12,"discounted_cash":5172.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide (6 month) per 7.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9217","type":"HCPCS"},{"code":"62935045345","type":"NDC"}],"standard_charges":[{"gross_charge":20691.12,"discounted_cash":5172.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"409491111","type":"NDC"}],"standard_charges":[{"gross_charge":133.82,"discounted_cash":33.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminophylline per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"409592116","type":"NDC"}],"standard_charges":[{"gross_charge":122.79,"discounted_cash":30.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminophylline per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"409592101","type":"NDC"}],"standard_charges":[{"gross_charge":122.79,"discounted_cash":30.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel-protein bound per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9264","type":"HCPCS"},{"code":"71288018350","type":"NDC"}],"standard_charges":[{"gross_charge":6806.14,"discounted_cash":1701.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel-protein bound per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9264","type":"HCPCS"},{"code":"781353191","type":"NDC"}],"standard_charges":[{"gross_charge":5800.15,"discounted_cash":1450.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel-protein bound per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9264","type":"HCPCS"},{"code":"60505623004","type":"NDC"}],"standard_charges":[{"gross_charge":12554.51,"discounted_cash":3138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLitaxel-protein bound per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9264","type":"HCPCS"},{"code":"68817013450","type":"NDC"}],"standard_charges":[{"gross_charge":11800.69,"discounted_cash":2950.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517912001","type":"NDC"}],"standard_charges":[{"gross_charge":88.7,"discounted_cash":22.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409434616","type":"NDC"}],"standard_charges":[{"gross_charge":49.48,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517912025","type":"NDC"}],"standard_charges":[{"gross_charge":88.7,"discounted_cash":22.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409434673","type":"NDC"}],"standard_charges":[{"gross_charge":49.48,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"36000000824","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL (10 %) syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409163110","type":"NDC"}],"standard_charges":[{"gross_charge":90.92,"discounted_cash":22.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL (10 %) syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409492834","type":"NDC"}],"standard_charges":[{"gross_charge":117.73,"discounted_cash":29.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL (10 %) syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"76329330401","type":"NDC"}],"standard_charges":[{"gross_charge":69.48,"discounted_cash":17.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"338500341","type":"NDC"}],"standard_charges":[{"gross_charge":161.24,"discounted_cash":40.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"264315511","type":"NDC"}],"standard_charges":[{"gross_charge":176.5,"discounted_cash":44.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alteplase per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004413","type":"NDC"}],"standard_charges":[{"gross_charge":31902.14,"discounted_cash":7975.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alteplase per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004406","type":"NDC"}],"standard_charges":[{"gross_charge":31902.14,"discounted_cash":7975.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alteplase per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242008525","type":"NDC"}],"standard_charges":[{"gross_charge":63804.28,"discounted_cash":15951.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0610","type":"HCPCS"},{"code":"63323031161","type":"NDC"}],"standard_charges":[{"gross_charge":67.41,"discounted_cash":16.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0610","type":"HCPCS"},{"code":"63323031150","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0610","type":"HCPCS"},{"code":"63323031110","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0610","type":"HCPCS"},{"code":"63323031166","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0610","type":"HCPCS"},{"code":"63323031159","type":"NDC"}],"standard_charges":[{"gross_charge":50.17,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0610","type":"HCPCS"},{"code":"63323031119","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alteplase per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242008527","type":"NDC"}],"standard_charges":[{"gross_charge":63804.28,"discounted_cash":15951.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918070026","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradiol cypionate per 5 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1000","type":"HCPCS"},{"code":"9027101","type":"NDC"}],"standard_charges":[{"gross_charge":323.48,"discounted_cash":80.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose 100 mg iron/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"781348695","type":"NDC"}],"standard_charges":[{"gross_charge":121.33,"discounted_cash":30.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"76045000901","type":"NDC"}],"standard_charges":[{"gross_charge":17.91,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323085225","type":"NDC"}],"standard_charges":[{"gross_charge":22.55,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323085203","type":"NDC"}],"standard_charges":[{"gross_charge":22.19,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"76045000910","type":"NDC"}],"standard_charges":[{"gross_charge":21.78,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409128303","type":"NDC"}],"standard_charges":[{"gross_charge":14.17,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409128331","type":"NDC"}],"standard_charges":[{"gross_charge":14.17,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"53768091","type":"NDC"}],"standard_charges":[{"gross_charge":257.76,"discounted_cash":64.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"13533069220","type":"NDC"}],"standard_charges":[{"gross_charge":316.74,"discounted_cash":79.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL (J7060) or 1000 mL (J7070)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"63323062404","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL (J7060) or 1000 mL (J7070)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"63323062475","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338954301","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"338954306","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"338954304","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"gross_charge":17.91,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338954302","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409128317","type":"NDC"}],"standard_charges":[{"gross_charge":25.16,"discounted_cash":6.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 2 mg/mL syringe 1 mL Cartridge","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409131230","type":"NDC"}],"standard_charges":[{"gross_charge":18.27,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone in 0.9 % NaCl per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70092911450","type":"NDC"}],"standard_charges":[{"gross_charge":96.52,"discounted_cash":24.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone in 0.9 % NaCl per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"97710501201","type":"NDC"}],"standard_charges":[{"gross_charge":62.81,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone in 0.9 % NaCl per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70092111450","type":"NDC"}],"standard_charges":[{"gross_charge":84.26,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone in 0.9 % NaCl per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71266911003","type":"NDC"}],"standard_charges":[{"gross_charge":148.99,"discounted_cash":37.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409426411","type":"NDC"}],"standard_charges":[{"gross_charge":17.16,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409426401","type":"NDC"}],"standard_charges":[{"gross_charge":17.16,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"76045000996","type":"NDC"}],"standard_charges":[{"gross_charge":9.88,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":9.88,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409128304","type":"NDC"}],"standard_charges":[{"gross_charge":18.02,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409128305","type":"NDC"}],"standard_charges":[{"gross_charge":18.02,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 2 mg/mL syringe 1 mL Cartridge","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409131203","type":"NDC"}],"standard_charges":[{"gross_charge":18.27,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 2 mg/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"76045001010","type":"NDC"}],"standard_charges":[{"gross_charge":24.88,"discounted_cash":6.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409128337","type":"NDC"}],"standard_charges":[{"gross_charge":25.16,"discounted_cash":6.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"63323062359","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028565","type":"NDC"}],"standard_charges":[{"gross_charge":172.35,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole per 200 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"97710500101","type":"NDC"}],"standard_charges":[{"gross_charge":13.41,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amphotericin B liposome per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0289","type":"HCPCS"},{"code":"97710514001","type":"NDC"}],"standard_charges":[{"gross_charge":2014.35,"discounted_cash":503.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"datopotamab deruxtecan-dlnk 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9011","type":"HCPCS"},{"code":"65597080101","type":"NDC"}],"standard_charges":[{"gross_charge":38087.66,"discounted_cash":9521.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ustekinumab-stba 90mg/1mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5099","type":"HCPCS"},{"code":"72606002801","type":"NDC"}],"standard_charges":[{"gross_charge":30951.76,"discounted_cash":7737.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone per 1 mg","drug_information":{"unit":1.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"55150032925","type":"NDC"}],"standard_charges":[{"gross_charge":179.51,"discounted_cash":44.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone per 1 mg","drug_information":{"unit":1.001,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"55150032901","type":"NDC"}],"standard_charges":[{"gross_charge":179.5,"discounted_cash":44.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"66993037083","type":"NDC"}],"standard_charges":[{"gross_charge":281.43,"discounted_cash":70.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"548540000","type":"NDC"}],"standard_charges":[{"gross_charge":133.74,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"59762453701","type":"NDC"}],"standard_charges":[{"gross_charge":309.46,"discounted_cash":77.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"medroxyPROGESTERone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"703680101","type":"NDC"}],"standard_charges":[{"gross_charge":403.15,"discounted_cash":100.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tarlatamab-dlle 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9026","type":"HCPCS"},{"code":"55513010301","type":"NDC"}],"standard_charges":[{"gross_charge":11452.08,"discounted_cash":2863.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tarlatamab-dlle 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9026","type":"HCPCS"},{"code":"55513005901","type":"NDC"}],"standard_charges":[{"gross_charge":11452.08,"discounted_cash":2863.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tarlatamab-dlle 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9026","type":"HCPCS"},{"code":"55513006901","type":"NDC"}],"standard_charges":[{"gross_charge":114612.75,"discounted_cash":28653.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tarlatamab-dlle 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9026","type":"HCPCS"},{"code":"55513007701","type":"NDC"}],"standard_charges":[{"gross_charge":114612.75,"discounted_cash":28653.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028564","type":"NDC"}],"standard_charges":[{"gross_charge":286.48,"discounted_cash":71.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"63323062310","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"25021060820","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004401","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70512084025","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70512084001","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"71288030302","type":"NDC"}],"standard_charges":[{"gross_charge":17.69,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"71288030301","type":"NDC"}],"standard_charges":[{"gross_charge":17.69,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004400","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"69680011201","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"517003101","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004444","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004441","type":"NDC"}],"standard_charges":[{"gross_charge":16.39,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"69680011225","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70069000510","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70069000501","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyanocobalamin per 1000 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"517003125","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3% per 1 mL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"264780510","type":"NDC"}],"standard_charges":[{"gross_charge":8.43,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3% per 1 mL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"338005403","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3% per 1 mL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"63323053021","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Denosumab-bnht (Bomyntra/Conexxence) Biosimilar, 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65219066801","type":"NDC"}],"standard_charges":[{"gross_charge":11423.89,"discounted_cash":2855.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Denosumab-bnht (Bomyntra/Conexxence) Biosimilar, 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65219067001","type":"NDC"}],"standard_charges":[{"gross_charge":21013.52,"discounted_cash":5253.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"denosumab-bnht 120 mg/1.7 mL (70 mg/mL) syringe 1.7 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65219067201","type":"NDC"}],"standard_charges":[{"gross_charge":17909.31,"discounted_cash":4477.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517100125","type":"NDC"}],"standard_charges":[{"gross_charge":27.89,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517100101","type":"NDC"}],"standard_charges":[{"gross_charge":27.89,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729052663","type":"NDC"}],"standard_charges":[{"gross_charge":22.47,"discounted_cash":5.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729052608","type":"NDC"}],"standard_charges":[{"gross_charge":22.47,"discounted_cash":5.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517100425","type":"NDC"}],"standard_charges":[{"gross_charge":34.39,"discounted_cash":8.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517100401","type":"NDC"}],"standard_charges":[{"gross_charge":34.39,"discounted_cash":8.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"immune globulin (human) (IgG) per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"944270012","type":"NDC"}],"standard_charges":[{"gross_charge":10462.03,"discounted_cash":2615.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"immune globulin (human) (IgG) per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"944270011","type":"NDC"}],"standard_charges":[{"gross_charge":5231.01,"discounted_cash":1307.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"immune globulin (human) (IgG) per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"944270010","type":"NDC"}],"standard_charges":[{"gross_charge":2615.51,"discounted_cash":653.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"immune globulin (human) (IgG) per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"944270006","type":"NDC"}],"standard_charges":[{"gross_charge":10462.03,"discounted_cash":2615.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"immune globulin (human) (IgG) per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"944270005","type":"NDC"}],"standard_charges":[{"gross_charge":5231.01,"discounted_cash":1307.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"immune globulin (human) (IgG) per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"944270004","type":"NDC"}],"standard_charges":[{"gross_charge":2615.51,"discounted_cash":653.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"influenza vaccine trivalent high dose 180 mcg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90662","type":"HCPCS"},{"code":"49281012565","type":"NDC"}],"standard_charges":[{"gross_charge":426.77,"discounted_cash":106.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"influenza vaccine trivalent high dose 180 mcg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90662","type":"HCPCS"},{"code":"49281012588","type":"NDC"}],"standard_charges":[{"gross_charge":426.77,"discounted_cash":106.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"influenza vaccine trivalent 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"58160091252","type":"NDC"}],"standard_charges":[{"gross_charge":99.09,"discounted_cash":24.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dacarbazine per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"143924501","type":"NDC"}],"standard_charges":[{"gross_charge":83.95,"discounted_cash":20.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dacarbazine per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"703507501","type":"NDC"}],"standard_charges":[{"gross_charge":126.93,"discounted_cash":31.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Denosumab-nxxp 60mg/1mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"78206019301","type":"NDC"}],"standard_charges":[{"gross_charge":6022.83,"discounted_cash":1505.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Denosumab-nxxp 120mg/1.7mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"78206019501","type":"NDC"}],"standard_charges":[{"gross_charge":12045.66,"discounted_cash":3011.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"influenza vaccine trivalent 45 mcg (15 mcg x 3)/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"58160091241","type":"NDC"}],"standard_charges":[{"gross_charge":99.09,"discounted_cash":24.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"immune globulin (human) (IgG) per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"944270008","type":"NDC"}],"standard_charges":[{"gross_charge":523.1,"discounted_cash":130.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"264420452","type":"NDC"}],"standard_charges":[{"gross_charge":32.56,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"47335099201","type":"NDC"}],"standard_charges":[{"gross_charge":21.07,"discounted_cash":5.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"338170840","type":"NDC"}],"standard_charges":[{"gross_charge":97.28,"discounted_cash":24.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457055300","type":"NDC"}],"standard_charges":[{"gross_charge":120.65,"discounted_cash":30.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010603","type":"NDC"}],"standard_charges":[{"gross_charge":58.98,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010602","type":"NDC"}],"standard_charges":[{"gross_charge":119.88,"discounted_cash":29.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042024","type":"NDC"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042000","type":"NDC"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010626","type":"NDC"}],"standard_charges":[{"gross_charge":58.98,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010605","type":"NDC"}],"standard_charges":[{"gross_charge":119.88,"discounted_cash":29.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409672924","type":"NDC"}],"standard_charges":[{"gross_charge":52.09,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cytarabine PF per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703031922","type":"NDC"}],"standard_charges":[{"gross_charge":84.87,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cytarabine PF per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"67457045220","type":"NDC"}],"standard_charges":[{"gross_charge":57.45,"discounted_cash":14.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cytarabine PF per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"63323012020","type":"NDC"}],"standard_charges":[{"gross_charge":177.71,"discounted_cash":44.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3% per 1 mL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"63323053075","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70860050141","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121171901","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121171909","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121171902","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"immune globulin (human) (IgG) per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"944270002","type":"NDC"}],"standard_charges":[{"gross_charge":523.1,"discounted_cash":130.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin in dextrose 5 % 1.5 gram/300 mL piggyback 300 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"338012404","type":"NDC"}],"standard_charges":[{"gross_charge":119.5,"discounted_cash":29.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72606003801","type":"NDC"}],"standard_charges":[{"gross_charge":21398.74,"discounted_cash":5349.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72606003701","type":"NDC"}],"standard_charges":[{"gross_charge":11569.74,"discounted_cash":2892.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Denosumab-bbdz (Jubbonti/Wyost) Biosimilar, 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"61314022894","type":"NDC"}],"standard_charges":[{"gross_charge":22894.36,"discounted_cash":5723.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Denosumab-bbdz (Jubbonti/Wyost) Biosimilar, 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"61314024063","type":"NDC"}],"standard_charges":[{"gross_charge":11447.18,"discounted_cash":2861.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"83634050081","type":"NDC"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"83634050041","type":"NDC"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 0.25 mg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"409180510","type":"NDC"}],"standard_charges":[{"gross_charge":20.62,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone 0.25 mg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"409180501","type":"NDC"}],"standard_charges":[{"gross_charge":20.62,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pegfilgrastim-cbqv 6 mg/0.6 mL syringe, w/ wearable injector 0.6 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"69448002763","type":"NDC"}],"standard_charges":[{"gross_charge":9613.3,"discounted_cash":2403.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615900","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"781336794","type":"NDC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"44567080310","type":"NDC"}],"standard_charges":[{"gross_charge":129.23,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"206885508","type":"NDC"}],"standard_charges":[{"gross_charge":86.87,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"romiPLOStim per 10 mcg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55513022301","type":"NDC"}],"standard_charges":[{"gross_charge":11033.85,"discounted_cash":2758.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"luspatercept-aamt 75 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0896","type":"HCPCS"},{"code":"59572077501","type":"NDC"}],"standard_charges":[{"gross_charge":92434.6,"discounted_cash":23108.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"luspatercept-aamt 25 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0896","type":"HCPCS"},{"code":"59572071101","type":"NDC"}],"standard_charges":[{"gross_charge":30811.66,"discounted_cash":7702.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pegfilgrastim-bmez 6 mg/0.6 mL syringe 0.6 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5120","type":"HCPCS"},{"code":"61314086601","type":"NDC"}],"standard_charges":[{"gross_charge":29092.3,"discounted_cash":7273.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 0.1 mg/mL solution 5 mL AMPUL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2372","type":"HCPCS"},{"code":"70069059110","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 0.1 mg/mL solution 5 mL AMPUL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2372","type":"HCPCS"},{"code":"70069059101","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 0.1 mg/mL solution 5 mL Vial","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2372","type":"HCPCS"},{"code":"43598017225","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 0.1 mg/mL solution 5 mL Vial","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2372","type":"HCPCS"},{"code":"641624510","type":"NDC"}],"standard_charges":[{"gross_charge":5.12,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 0.1 mg/mL solution 5 mL Vial","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2372","type":"HCPCS"},{"code":"641624501","type":"NDC"}],"standard_charges":[{"gross_charge":5.12,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 0.1 mg/mL solution 5 mL AMPUL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2372","type":"HCPCS"},{"code":"43598017215","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine HCl 0.1 mg/mL solution 5 mL AMPUL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2372","type":"HCPCS"},{"code":"43598017205","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"riTUXimab-abbs 10 mg/mL solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":18485.88,"discounted_cash":4621.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"409338513","type":"NDC"}],"standard_charges":[{"gross_charge":66.48,"discounted_cash":16.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"781311395","type":"NDC"}],"standard_charges":[{"gross_charge":22.85,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enfortumab vedotin-ejfv 20 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"51144002001","type":"NDC"}],"standard_charges":[{"gross_charge":21516.94,"discounted_cash":5379.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615600","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"25021016430","type":"NDC"}],"standard_charges":[{"gross_charge":21.39,"discounted_cash":5.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"206885208","type":"NDC"}],"standard_charges":[{"gross_charge":43.44,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"206885216","type":"NDC"}],"standard_charges":[{"gross_charge":43.44,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"63323098353","type":"NDC"}],"standard_charges":[{"gross_charge":17.82,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"63323098341","type":"NDC"}],"standard_charges":[{"gross_charge":17.82,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"409338511","type":"NDC"}],"standard_charges":[{"gross_charge":66.48,"discounted_cash":16.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"gross_charge":14.78,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615700","type":"NDC"}],"standard_charges":[{"gross_charge":14.78,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"63323030030","type":"NDC"}],"standard_charges":[{"gross_charge":27.31,"discounted_cash":6.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"25021016530","type":"NDC"}],"standard_charges":[{"gross_charge":26.73,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam per 1.125 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"781311390","type":"NDC"}],"standard_charges":[{"gross_charge":22.85,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"riTUXimab-abbs 10 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":3697.18,"discounted_cash":924.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trastuzumab-dkst 420 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"83257000311","type":"NDC"}],"standard_charges":[{"gross_charge":11857.68,"discounted_cash":2964.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trastuzumab-dkst 420 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"67457084744","type":"NDC"}],"standard_charges":[{"gross_charge":13147.24,"discounted_cash":3286.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"65145010701","type":"NDC"}],"standard_charges":[{"gross_charge":27.12,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001510","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001501","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028557","type":"NDC"}],"standard_charges":[{"gross_charge":286.48,"discounted_cash":71.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028551","type":"NDC"}],"standard_charges":[{"gross_charge":172.35,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"55150019520","type":"NDC"}],"standard_charges":[{"gross_charge":44.12,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"409930021","type":"NDC"}],"standard_charges":[{"gross_charge":28.95,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"409930020","type":"NDC"}],"standard_charges":[{"gross_charge":28.95,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028573","type":"NDC"}],"standard_charges":[{"gross_charge":344.7,"discounted_cash":86.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028568","type":"NDC"}],"standard_charges":[{"gross_charge":172.35,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trastuzumab-anns 420 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5117","type":"HCPCS"},{"code":"55513013201","type":"NDC"}],"standard_charges":[{"gross_charge":17215.77,"discounted_cash":4303.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate in sodium chloride 2 gram/100 mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"80830236301","type":"NDC"}],"standard_charges":[{"gross_charge":134.82,"discounted_cash":33.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate in sodium chloride 2 gram/100 mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"44567062124","type":"NDC"}],"standard_charges":[{"gross_charge":138.65,"discounted_cash":34.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"65145010710","type":"NDC"}],"standard_charges":[{"gross_charge":27.12,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028600","type":"NDC"}],"standard_charges":[{"gross_charge":226.74,"discounted_cash":56.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028635","type":"NDC"}],"standard_charges":[{"gross_charge":36.08,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028638","type":"NDC"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":8.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trastuzumab-dkst 420 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"67457084550","type":"NDC"}],"standard_charges":[{"gross_charge":13147.24,"discounted_cash":3286.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trastuzumab-anns 150 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5117","type":"HCPCS"},{"code":"55513014101","type":"NDC"}],"standard_charges":[{"gross_charge":6148.53,"discounted_cash":1537.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1,000 mg/100 mL (10 mg/mL) piggyback 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"14789011508","type":"NDC"}],"standard_charges":[{"gross_charge":124.86,"discounted_cash":31.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1,000 mg/100 mL (10 mg/mL) piggyback 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"14789011505","type":"NDC"}],"standard_charges":[{"gross_charge":124.86,"discounted_cash":31.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1,000 mg/100 mL (10 mg/mL) piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021041882","type":"NDC"}],"standard_charges":[{"gross_charge":61.28,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1,000 mg/100 mL (10 mg/mL) piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"80830232902","type":"NDC"}],"standard_charges":[{"gross_charge":130.22,"discounted_cash":32.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1,000 mg/100 mL (10 mg/mL) piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"80830232901","type":"NDC"}],"standard_charges":[{"gross_charge":130.22,"discounted_cash":32.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enfortumab vedotin-ejfv 30 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"51144003001","type":"NDC"}],"standard_charges":[{"gross_charge":32194.75,"discounted_cash":8048.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1,000 mg/100 mL (10 mg/mL) piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"51754010803","type":"NDC"}],"standard_charges":[{"gross_charge":54.39,"discounted_cash":13.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006425","type":"NDC"}],"standard_charges":[{"gross_charge":30.56,"discounted_cash":7.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002310","type":"NDC"}],"standard_charges":[{"gross_charge":35.85,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002301","type":"NDC"}],"standard_charges":[{"gross_charge":35.85,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028643","type":"NDC"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":8.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006401","type":"NDC"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":6.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028611","type":"NDC"}],"standard_charges":[{"gross_charge":36.08,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ropivacaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"55150019720","type":"NDC"}],"standard_charges":[{"gross_charge":17.46,"discounted_cash":4.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1,000 mg/100 mL (10 mg/mL) piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"51754010801","type":"NDC"}],"standard_charges":[{"gross_charge":54.39,"discounted_cash":13.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dacarbazine per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"143924510","type":"NDC"}],"standard_charges":[{"gross_charge":83.95,"discounted_cash":20.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fam-trastuzumab deruxtecan-nxki 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9358","type":"HCPCS"},{"code":"65597040601","type":"NDC"}],"standard_charges":[{"gross_charge":21595.15,"discounted_cash":5398.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bevacizumab-bvzr per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5118","type":"HCPCS"},{"code":"69034201","type":"NDC"}],"standard_charges":[{"gross_charge":2641.29,"discounted_cash":660.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine in 0.9 % sod chloride 4 mg/250 mL (16 mcg/mL) solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"42023031501","type":"NDC"}],"standard_charges":[{"gross_charge":231.72,"discounted_cash":57.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine 1,000 mcg/10 mL (100 mcg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"39822200001","type":"NDC"}],"standard_charges":[{"gross_charge":125.09,"discounted_cash":31.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloNIDine 1,000 mcg/10 mL (100 mcg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"67457021810","type":"NDC"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":55.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fecal microbiota, live-jslm 150 mL enema 150 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1440","type":"HCPCS"},{"code":"55566980002","type":"NDC"}],"standard_charges":[{"gross_charge":38367.0,"discounted_cash":9591.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fecal microbiota, live-jslm 150 mL enema 150 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1440","type":"HCPCS"},{"code":"55566980000","type":"NDC"}],"standard_charges":[{"gross_charge":38367.0,"discounted_cash":9591.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, mirvetuximab soravtansine-gync, 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72903085301","type":"NDC"}],"standard_charges":[{"gross_charge":50682.7,"discounted_cash":12670.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indigotindisulfonate sodium 8 mg/mL (0.8 %) solution 5 mL AMPUL","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9220","type":"HCPCS"},{"code":"81284031505","type":"NDC"}],"standard_charges":[{"gross_charge":986.03,"discounted_cash":246.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"indigotindisulfonate sodium 8 mg/mL (0.8 %) solution 5 mL AMPUL","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9220","type":"HCPCS"},{"code":"81284031500","type":"NDC"}],"standard_charges":[{"gross_charge":986.03,"discounted_cash":246.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pegfilgrastim-pbbk 6 mg/0.6 mL syringe 0.6 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5130","type":"HCPCS"},{"code":"70121162701","type":"NDC"}],"standard_charges":[{"gross_charge":9263.81,"discounted_cash":2315.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric carboxymaltose 100 mg iron/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"517060201","type":"NDC"}],"standard_charges":[{"gross_charge":1423.61,"discounted_cash":355.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Measles/Mumps/Rubella Vaccine 0.5 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90707","type":"HCPCS"},{"code":"58160083103","type":"NDC"}],"standard_charges":[{"gross_charge":623.76,"discounted_cash":155.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Measles/Mumps/Rubella Vaccine 0.5 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90707","type":"HCPCS"},{"code":"58160082415","type":"NDC"}],"standard_charges":[{"gross_charge":623.76,"discounted_cash":155.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed disodium 1,000 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"71288014851","type":"NDC"}],"standard_charges":[{"gross_charge":1077.46,"discounted_cash":269.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed disodium 1,000 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"43598037074","type":"NDC"}],"standard_charges":[{"gross_charge":659.14,"discounted_cash":164.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed disodium 1,000 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"55150038301","type":"NDC"}],"standard_charges":[{"gross_charge":2088.04,"discounted_cash":522.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine in 0.9 % sod chloride 4 mg/250 mL (16 mcg/mL) solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"42023031510","type":"NDC"}],"standard_charges":[{"gross_charge":231.72,"discounted_cash":57.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed disodium 1,000 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9296","type":"HCPCS"},{"code":"16729024438","type":"NDC"}],"standard_charges":[{"gross_charge":1079.83,"discounted_cash":269.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine in 0.9 % sod chloride 4 mg/250 mL (16 mcg/mL) solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"97710523803","type":"NDC"}],"standard_charges":[{"gross_charge":231.72,"discounted_cash":57.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole (2 month) ER 960 mg/3.2 mL suspension,extended rel syring 3.2 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0402","type":"HCPCS"},{"code":"59148011480","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pegfilgrastim-cbqv 6 mg/0.6 mL syringe, w/ wearable injector 0.6 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"70114013001","type":"NDC"}],"standard_charges":[{"gross_charge":19102.13,"discounted_cash":4775.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"human prothrombin complex(PCC)-lans per 1 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7165","type":"HCPCS"},{"code":"68982026181","type":"NDC"}],"standard_charges":[{"gross_charge":10.07,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"human prothrombin complex(PCC)-lans per 1 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7165","type":"HCPCS"},{"code":"68982026101","type":"NDC"}],"standard_charges":[{"gross_charge":10.07,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"human prothrombin complex (PCC)-lans per 1 units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7165","type":"HCPCS"},{"code":"68982026182","type":"NDC"}],"standard_charges":[{"gross_charge":10.07,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"human prothrombin complex (PCC)-lans per 1 units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7165","type":"HCPCS"},{"code":"68982026102","type":"NDC"}],"standard_charges":[{"gross_charge":10.07,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nirsevimab-alip 100 mg/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90381","type":"HCPCS"},{"code":"49281057488","type":"NDC"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":923.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nirsevimab-alip 100 mg/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90381","type":"HCPCS"},{"code":"49281057415","type":"NDC"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":923.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nirsevimab-alip 50 mg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90380","type":"HCPCS"},{"code":"49281057515","type":"NDC"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":923.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nirsevimab-alip 50 mg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90380","type":"HCPCS"},{"code":"49281057500","type":"NDC"}],"standard_charges":[{"gross_charge":3692.93,"discounted_cash":923.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epcoritamab-bysp 4 mg/0.8 mL solution 0.8 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9321","type":"HCPCS"},{"code":"82705000201","type":"NDC"}],"standard_charges":[{"gross_charge":10287.84,"discounted_cash":2571.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epcoritamab-bysp 48 mg/0.8 mL solution 0.8 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9321","type":"HCPCS"},{"code":"82705001001","type":"NDC"}],"standard_charges":[{"gross_charge":123454.46,"discounted_cash":30863.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE ER 250 mg/0.7 mL suspension,extended rel syring 0.7 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2799","type":"HCPCS"},{"code":"51759096010","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE ER 200 mg/0.56 mL suspension,extended rel syring 0.56 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2799","type":"HCPCS"},{"code":"51759085010","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE ER 100 mg/0.28 mL suspension,extended rel syring 0.28 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2799","type":"HCPCS"},{"code":"51759052010","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"risperiDONE ER 125 mg/0.35 mL suspension,extended rel syring 0.35 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2799","type":"HCPCS"},{"code":"51759063010","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole (2 month) ER 720 mg/2.4 mL suspension,extended rel syring 2.4 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0402","type":"HCPCS"},{"code":"59148010280","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nivolumab-relatlimab-rmbw 240-80 mg/20 mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9298","type":"HCPCS"},{"code":"3712511","type":"NDC"}],"standard_charges":[{"gross_charge":115526.43,"discounted_cash":28881.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate in sodium chloride 1 gram/100 mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"44567062224","type":"NDC"}],"standard_charges":[{"gross_charge":69.71,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate in sodium chloride 1 gram/100 mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"44567062201","type":"NDC"}],"standard_charges":[{"gross_charge":69.71,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polatuzumab vedotin-piiq 30 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9309","type":"HCPCS"},{"code":"50242010301","type":"NDC"}],"standard_charges":[{"gross_charge":30473.01,"discounted_cash":7618.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"belantamab mafodotin-blmf 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9037","type":"HCPCS"},{"code":"173089601","type":"NDC"}],"standard_charges":[{"gross_charge":3072.89,"discounted_cash":768.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Pertuzumab, trastuzumab, and hyaluronidase-zzdf, per 10mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242026001","type":"NDC"}],"standard_charges":[{"gross_charge":70886.64,"discounted_cash":17721.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Pertuzumab, trastuzumab, and hyaluronidase-zzdf, per 10mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242024501","type":"NDC"}],"standard_charges":[{"gross_charge":106334.09,"discounted_cash":26583.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lurbinectedin 4 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9223","type":"HCPCS"},{"code":"68727071201","type":"NDC"}],"standard_charges":[{"gross_charge":61967.33,"discounted_cash":15491.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, daratumumab, 10 mg and hyaluronidase-fihj","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9144","type":"HCPCS"},{"code":"57894050301","type":"NDC"}],"standard_charges":[{"gross_charge":70652.81,"discounted_cash":17663.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, sacituzumab govitecan-hziy, 2.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9317","type":"HCPCS"},{"code":"55135013201","type":"NDC"}],"standard_charges":[{"gross_charge":19203.31,"discounted_cash":4800.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isatuximab-irfc 20 mg/mL solution 25 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"24065601","type":"NDC"}],"standard_charges":[{"gross_charge":32203.98,"discounted_cash":8051.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isatuximab-irfc 20 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"24065401","type":"NDC"}],"standard_charges":[{"gross_charge":6440.76,"discounted_cash":1610.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, cefiderocol, 10mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0699","type":"HCPCS"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"gross_charge":1688.13,"discounted_cash":422.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, cefiderocol, 10mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0699","type":"HCPCS"},{"code":"59630026601","type":"NDC"}],"standard_charges":[{"gross_charge":1688.13,"discounted_cash":422.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trastuzumab-qyyp 420 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5116","type":"HCPCS"},{"code":"69030601","type":"NDC"}],"standard_charges":[{"gross_charge":11981.16,"discounted_cash":2995.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trastuzumab-qyyp 420 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5116","type":"HCPCS"},{"code":"69030501","type":"NDC"}],"standard_charges":[{"gross_charge":11981.16,"discounted_cash":2995.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"riTUXimab-pvvr 10 mg/mL solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"69024901","type":"NDC"}],"standard_charges":[{"gross_charge":14490.42,"discounted_cash":3622.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"riTUXimab-pvvr 10 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"69023801","type":"NDC"}],"standard_charges":[{"gross_charge":2898.08,"discounted_cash":724.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 untis","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69131801","type":"NDC"}],"standard_charges":[{"gross_charge":1392.93,"discounted_cash":348.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 untis","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69131810","type":"NDC"}],"standard_charges":[{"gross_charge":1392.93,"discounted_cash":348.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa-epbx 20,000 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69131101","type":"NDC"}],"standard_charges":[{"gross_charge":1392.92,"discounted_cash":348.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa-epbx 20,000 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69131110","type":"NDC"}],"standard_charges":[{"gross_charge":1392.92,"discounted_cash":348.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tisotumab vedotin-tftv, 1 mg inj","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9273","type":"HCPCS"},{"code":"51144000301","type":"NDC"}],"standard_charges":[{"gross_charge":54562.18,"discounted_cash":13640.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB PER 1 MG","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"3375614","type":"NDC"}],"standard_charges":[{"gross_charge":29750.92,"discounted_cash":7437.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pneumococcal 20-valent conjugate 0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"5200010","type":"NDC"}],"standard_charges":[{"gross_charge":1911.8,"discounted_cash":477.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pneumococcal 20-valent conjugate 0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"5200001","type":"NDC"}],"standard_charges":[{"gross_charge":1971.68,"discounted_cash":492.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amivantamab-vmjw 50 mg/mL solution 7 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9061","type":"HCPCS"},{"code":"57894050101","type":"NDC"}],"standard_charges":[{"gross_charge":29086.22,"discounted_cash":7271.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amivantamab-vmjw 50 mg/mL solution 7 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9061","type":"HCPCS"},{"code":"57894050100","type":"NDC"}],"standard_charges":[{"gross_charge":29086.22,"discounted_cash":7271.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47426050301","type":"NDC"}],"standard_charges":[{"gross_charge":1132.45,"discounted_cash":283.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bevacizumab-bvzr per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5118","type":"HCPCS"},{"code":"69031501","type":"NDC"}],"standard_charges":[{"gross_charge":660.32,"discounted_cash":165.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47426030305","type":"NDC"}],"standard_charges":[{"gross_charge":1012.94,"discounted_cash":253.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47426030301","type":"NDC"}],"standard_charges":[{"gross_charge":1169.93,"discounted_cash":292.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47426050102","type":"NDC"}],"standard_charges":[{"gross_charge":2245.07,"discounted_cash":561.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47426030106","type":"NDC"}],"standard_charges":[{"gross_charge":2245.07,"discounted_cash":561.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47426030104","type":"NDC"}],"standard_charges":[{"gross_charge":1999.81,"discounted_cash":499.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47426030102","type":"NDC"}],"standard_charges":[{"gross_charge":2105.44,"discounted_cash":526.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"riTUXimab-ar 10 mg/mL solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513032601","type":"NDC"}],"standard_charges":[{"gross_charge":26561.05,"discounted_cash":6640.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"riTUXimab-ar 10 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513022401","type":"NDC"}],"standard_charges":[{"gross_charge":5312.21,"discounted_cash":1328.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47426030303","type":"NDC"}],"standard_charges":[{"gross_charge":1012.94,"discounted_cash":253.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dacarbazine per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"63323012800","type":"NDC"}],"standard_charges":[{"gross_charge":47.85,"discounted_cash":11.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dacarbazine per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"71288017421","type":"NDC"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":17.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dacarbazine per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9130","type":"HCPCS"},{"code":"63323012820","type":"NDC"}],"standard_charges":[{"gross_charge":47.85,"discounted_cash":11.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"143928401","type":"NDC"}],"standard_charges":[{"gross_charge":47.12,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"55150020210","type":"NDC"}],"standard_charges":[{"gross_charge":11.86,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"55150020200","type":"NDC"}],"standard_charges":[{"gross_charge":11.86,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"8092360","type":"NDC"}],"standard_charges":[{"gross_charge":36.78,"discounted_cash":9.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"8092351","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"143909301","type":"NDC"}],"standard_charges":[{"gross_charge":2688.12,"discounted_cash":672.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"69403701","type":"NDC"}],"standard_charges":[{"gross_charge":255.08,"discounted_cash":63.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"517190525","type":"NDC"}],"standard_charges":[{"gross_charge":23.25,"discounted_cash":5.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"143925225","type":"NDC"}],"standard_charges":[{"gross_charge":19.07,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"143925201","type":"NDC"}],"standard_charges":[{"gross_charge":19.07,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"409582011","type":"NDC"}],"standard_charges":[{"gross_charge":27.35,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"409582001","type":"NDC"}],"standard_charges":[{"gross_charge":27.35,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin in dextrose (iso-os) per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"338350341","type":"NDC"}],"standard_charges":[{"gross_charge":36.77,"discounted_cash":9.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066400","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"143928410","type":"NDC"}],"standard_charges":[{"gross_charge":47.12,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066441","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"781323295","type":"NDC"}],"standard_charges":[{"gross_charge":12.13,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"25021075110","type":"NDC"}],"standard_charges":[{"gross_charge":11.24,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methacholine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"64281010006","type":"NDC"}],"standard_charges":[{"gross_charge":649.38,"discounted_cash":162.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methacholine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"64281010000","type":"NDC"}],"standard_charges":[{"gross_charge":659.77,"discounted_cash":164.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droPERidol 2.5 mg/mL solution 1 mL Vial","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"143951525","type":"NDC"}],"standard_charges":[{"gross_charge":90.45,"discounted_cash":22.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droPERidol 2.5 mg/mL solution 1 mL Vial","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"143951501","type":"NDC"}],"standard_charges":[{"gross_charge":90.45,"discounted_cash":22.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droPERidol 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"143951425","type":"NDC"}],"standard_charges":[{"gross_charge":21.89,"discounted_cash":5.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droPERidol 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"143951401","type":"NDC"}],"standard_charges":[{"gross_charge":21.89,"discounted_cash":5.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droPERidol 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":0.125,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"517970201","type":"NDC"}],"standard_charges":[{"gross_charge":7.64,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droPERidol 2.5 mg/mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"517970225","type":"NDC"}],"standard_charges":[{"gross_charge":61.11,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"70095002402","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"70095002401","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"71288060011","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"71288060010","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"31722020431","type":"NDC"}],"standard_charges":[{"gross_charge":14.9,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"31722020410","type":"NDC"}],"standard_charges":[{"gross_charge":14.9,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"25021075111","type":"NDC"}],"standard_charges":[{"gross_charge":13.34,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pantoprazole per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9113","type":"HCPCS"},{"code":"781323294","type":"NDC"}],"standard_charges":[{"gross_charge":12.13,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"72485010125","type":"NDC"}],"standard_charges":[{"gross_charge":20.48,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"72485010101","type":"NDC"}],"standard_charges":[{"gross_charge":20.48,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066416","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"31722096331","type":"NDC"}],"standard_charges":[{"gross_charge":162.67,"discounted_cash":40.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"72266012705","type":"NDC"}],"standard_charges":[{"gross_charge":58.08,"discounted_cash":14.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"72266012701","type":"NDC"}],"standard_charges":[{"gross_charge":58.08,"discounted_cash":14.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"31722096332","type":"NDC"}],"standard_charges":[{"gross_charge":162.67,"discounted_cash":40.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"17478001502","type":"NDC"}],"standard_charges":[{"gross_charge":266.77,"discounted_cash":66.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"14789001007","type":"NDC"}],"standard_charges":[{"gross_charge":125.81,"discounted_cash":31.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"14789001002","type":"NDC"}],"standard_charges":[{"gross_charge":125.81,"discounted_cash":31.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"517198005","type":"NDC"}],"standard_charges":[{"gross_charge":48.21,"discounted_cash":12.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"517198001","type":"NDC"}],"standard_charges":[{"gross_charge":48.21,"discounted_cash":12.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"58914008052","type":"NDC"}],"standard_charges":[{"gross_charge":609.43,"discounted_cash":152.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339013705","type":"NDC"}],"standard_charges":[{"gross_charge":253.78,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339013701","type":"NDC"}],"standard_charges":[{"gross_charge":253.78,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"409321311","type":"NDC"}],"standard_charges":[{"gross_charge":289.7,"discounted_cash":72.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"409321312","type":"NDC"}],"standard_charges":[{"gross_charge":289.7,"discounted_cash":72.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"47335017840","type":"NDC"}],"standard_charges":[{"gross_charge":1915.0,"discounted_cash":478.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"70436014780","type":"NDC"}],"standard_charges":[{"gross_charge":55.92,"discounted_cash":13.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dicyclomine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"70436014781","type":"NDC"}],"standard_charges":[{"gross_charge":55.92,"discounted_cash":13.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676034000","type":"NDC"}],"standard_charges":[{"gross_charge":7299.85,"discounted_cash":1824.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676034001","type":"NDC"}],"standard_charges":[{"gross_charge":7299.85,"discounted_cash":1824.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"641037625","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"641037621","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydrAMINE per 50 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"67457012410","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate 200 mg/mL suspension for reconstitution 160 mL Bottle","drug_information":{"unit":0.00781,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"4026129","type":"NDC"}],"standard_charges":[{"gross_charge":42.89,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate 200 mg/mL suspension for reconstitution 160 mL Bottle","drug_information":{"unit":0.00781,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"527516082","type":"NDC"}],"standard_charges":[{"gross_charge":18.24,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate 200 mg/mL suspension for reconstitution 160 mL Bottle","drug_information":{"unit":0.00781,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"66689030708","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mycophenolate 200 mg/mL suspension for reconstitution 2.5 mL Syringe","drug_information":{"unit":0.01563,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"97710211603","type":"NDC"}],"standard_charges":[{"gross_charge":60.56,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin liposomal per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"47335004940","type":"NDC"}],"standard_charges":[{"gross_charge":1554.37,"discounted_cash":388.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric gluconate per 12.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"24279401","type":"NDC"}],"standard_charges":[{"gross_charge":64.15,"discounted_cash":16.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric gluconate per 12.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"143957010","type":"NDC"}],"standard_charges":[{"gross_charge":64.42,"discounted_cash":16.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric gluconate per 12.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"143957001","type":"NDC"}],"standard_charges":[{"gross_charge":64.42,"discounted_cash":16.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric gluconate per 12.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"24279410","type":"NDC"}],"standard_charges":[{"gross_charge":64.15,"discounted_cash":16.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric gluconate per 12.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"24279210","type":"NDC"}],"standard_charges":[{"gross_charge":227.04,"discounted_cash":56.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophilic factor (recomb) 1,000 (+/-) unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944284310","type":"NDC"}],"standard_charges":[{"gross_charge":11919.42,"discounted_cash":2979.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophilic factor (recomb) per 1 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944093501","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dimenhydrinate per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1240","type":"HCPCS"},{"code":"63323036601","type":"NDC"}],"standard_charges":[{"gross_charge":36.61,"discounted_cash":9.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric gluconate per 12.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"24279201","type":"NDC"}],"standard_charges":[{"gross_charge":227.04,"discounted_cash":56.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin 50 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"47335017640","type":"NDC"}],"standard_charges":[{"gross_charge":957.5,"discounted_cash":239.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin liposomal per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"47335005040","type":"NDC"}],"standard_charges":[{"gross_charge":3899.51,"discounted_cash":974.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin liposomal per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"43598054125","type":"NDC"}],"standard_charges":[{"gross_charge":5496.62,"discounted_cash":1374.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"argatroban per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9121","type":"HCPCS"},{"code":"409114001","type":"NDC"}],"standard_charges":[{"gross_charge":398.78,"discounted_cash":99.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"argatroban per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9121","type":"HCPCS"},{"code":"42023018201","type":"NDC"}],"standard_charges":[{"gross_charge":870.02,"discounted_cash":217.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"argatroban per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9121","type":"HCPCS"},{"code":"63323052603","type":"NDC"}],"standard_charges":[{"gross_charge":2498.62,"discounted_cash":624.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"argatroban per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9121","type":"HCPCS"},{"code":"143967401","type":"NDC"}],"standard_charges":[{"gross_charge":1355.21,"discounted_cash":338.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACTINomycin per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9120","type":"HCPCS"},{"code":"42658000801","type":"NDC"}],"standard_charges":[{"gross_charge":3049.91,"discounted_cash":762.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACTINomycin per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9120","type":"HCPCS"},{"code":"39822210002","type":"NDC"}],"standard_charges":[{"gross_charge":2537.6,"discounted_cash":634.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACTINomycin per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9120","type":"HCPCS"},{"code":"39822210001","type":"NDC"}],"standard_charges":[{"gross_charge":2537.6,"discounted_cash":634.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACTINomycin per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9120","type":"HCPCS"},{"code":"66993048983","type":"NDC"}],"standard_charges":[{"gross_charge":4825.8,"discounted_cash":1206.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACTINomycin per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9120","type":"HCPCS"},{"code":"55292081155","type":"NDC"}],"standard_charges":[{"gross_charge":8556.22,"discounted_cash":2139.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carmustine per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9050","type":"HCPCS"},{"code":"23155026131","type":"NDC"}],"standard_charges":[{"gross_charge":27331.95,"discounted_cash":6832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carmustine per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9050","type":"HCPCS"},{"code":"23155026141","type":"NDC"}],"standard_charges":[{"gross_charge":27331.95,"discounted_cash":6832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0169","type":"HCPCS"},{"code":"54288011925","type":"NDC"}],"standard_charges":[{"gross_charge":83.98,"discounted_cash":21.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0169","type":"HCPCS"},{"code":"54288011901","type":"NDC"}],"standard_charges":[{"gross_charge":83.98,"discounted_cash":21.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0169","type":"HCPCS"},{"code":"42023015901","type":"NDC"}],"standard_charges":[{"gross_charge":67.48,"discounted_cash":16.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0169","type":"HCPCS"},{"code":"42023015925","type":"NDC"}],"standard_charges":[{"gross_charge":67.48,"discounted_cash":16.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"argatroban per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9121","type":"HCPCS"},{"code":"67457021202","type":"NDC"}],"standard_charges":[{"gross_charge":833.79,"discounted_cash":208.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"97710524302","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"argatroban per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9121","type":"HCPCS"},{"code":"143928801","type":"NDC"}],"standard_charges":[{"gross_charge":1509.33,"discounted_cash":377.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"409648201","type":"NDC"}],"standard_charges":[{"gross_charge":443.61,"discounted_cash":110.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose 100 mg iron/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"781348675","type":"NDC"}],"standard_charges":[{"gross_charge":121.33,"discounted_cash":30.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose 100 mg iron/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"76329920101","type":"NDC"}],"standard_charges":[{"gross_charge":169.86,"discounted_cash":42.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose 100 mg iron/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"49230053401","type":"NDC"}],"standard_charges":[{"gross_charge":245.96,"discounted_cash":61.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose 100 mg iron/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"517234001","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":62.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose 100 mg iron/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"517234099","type":"NDC"}],"standard_charges":[{"gross_charge":228.08,"discounted_cash":57.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose 100 mg iron/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"517234010","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":62.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose 100 mg iron/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"49230053410","type":"NDC"}],"standard_charges":[{"gross_charge":245.96,"discounted_cash":61.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arsenic trioxide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"70121148307","type":"NDC"}],"standard_charges":[{"gross_charge":257.3,"discounted_cash":64.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arsenic trioxide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"70121148301","type":"NDC"}],"standard_charges":[{"gross_charge":257.3,"discounted_cash":64.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arsenic trioxide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"54879002710","type":"NDC"}],"standard_charges":[{"gross_charge":1514.54,"discounted_cash":378.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arsenic trioxide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"68382099710","type":"NDC"}],"standard_charges":[{"gross_charge":1053.79,"discounted_cash":263.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arsenic trioxide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"68382099701","type":"NDC"}],"standard_charges":[{"gross_charge":1053.79,"discounted_cash":263.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arsenic trioxide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"63323063710","type":"NDC"}],"standard_charges":[{"gross_charge":5551.05,"discounted_cash":1387.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arsenic trioxide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"63323063703","type":"NDC"}],"standard_charges":[{"gross_charge":5551.05,"discounted_cash":1387.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"erythromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"409648211","type":"NDC"}],"standard_charges":[{"gross_charge":443.61,"discounted_cash":110.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sirolimus per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"8104110","type":"NDC"}],"standard_charges":[{"gross_charge":129.2,"discounted_cash":32.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"6020801","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"60208000","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"97710522103","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004938","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004918","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338004911","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"264780010","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"409798437","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"409798309","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin liposomal per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"70710153101","type":"NDC"}],"standard_charges":[{"gross_charge":1957.9,"discounted_cash":489.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin liposomal per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"70710153001","type":"NDC"}],"standard_charges":[{"gross_charge":870.02,"discounted_cash":217.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin liposomal per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"338006301","type":"NDC"}],"standard_charges":[{"gross_charge":2391.15,"discounted_cash":597.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"264780009","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % amnioinfusion 0.9 % solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"264999910","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"264580210","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"990798355","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"990798361","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"990798309","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"990798437","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"990798423","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"76297000132","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin liposomal per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"43598028335","type":"NDC"}],"standard_charges":[{"gross_charge":2734.16,"discounted_cash":683.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"76297000122","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"76297000102","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338955050","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338952572","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"63323062376","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"63323062375","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"63323062374","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"63323062361","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride per 250 mL (J7050) or 500 mL (J7040) or 1000 mL (J7030)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7040","type":"HCPCS"},{"code":"17271070106","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7298","type":"HCPCS"},{"code":"50419042301","type":"NDC"}],"standard_charges":[{"gross_charge":9304.07,"discounted_cash":2326.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, infliximab, excludes biosimilar, 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"57894003001","type":"NDC"}],"standard_charges":[{"gross_charge":8717.54,"discounted_cash":2179.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016200","type":"NDC"}],"standard_charges":[{"gross_charge":101.56,"discounted_cash":25.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611072225","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611072201","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860070141","type":"NDC"}],"standard_charges":[{"gross_charge":14.7,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011825","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011801","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"338007225","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860070103","type":"NDC"}],"standard_charges":[{"gross_charge":14.7,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"47781058493","type":"NDC"}],"standard_charges":[{"gross_charge":6.07,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"47781058468","type":"NDC"}],"standard_charges":[{"gross_charge":6.07,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860070101","type":"NDC"}],"standard_charges":[{"gross_charge":11.08,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016216","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"409379519","type":"NDC"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"409379501","type":"NDC"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016101","type":"NDC"}],"standard_charges":[{"gross_charge":49.97,"discounted_cash":12.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016243","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"31722030501","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70512084301","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075601","type":"NDC"}],"standard_charges":[{"gross_charge":6.11,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"85117703","type":"NDC"}],"standard_charges":[{"gross_charge":1235.86,"discounted_cash":308.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"85113601","type":"NDC"}],"standard_charges":[{"gross_charge":3867.53,"discounted_cash":966.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"70436016380","type":"NDC"}],"standard_charges":[{"gross_charge":399.85,"discounted_cash":99.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"70436002780","type":"NDC"}],"standard_charges":[{"gross_charge":473.39,"discounted_cash":118.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"67457063110","type":"NDC"}],"standard_charges":[{"gross_charge":330.15,"discounted_cash":82.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"85113603","type":"NDC"}],"standard_charges":[{"gross_charge":3867.53,"discounted_cash":966.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9150","type":"HCPCS"},{"code":"42658002101","type":"NDC"}],"standard_charges":[{"gross_charge":1004.62,"discounted_cash":251.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9150","type":"HCPCS"},{"code":"143955110","type":"NDC"}],"standard_charges":[{"gross_charge":500.9,"discounted_cash":125.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9150","type":"HCPCS"},{"code":"143955101","type":"NDC"}],"standard_charges":[{"gross_charge":500.9,"discounted_cash":125.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9150","type":"HCPCS"},{"code":"703523311","type":"NDC"}],"standard_charges":[{"gross_charge":1037.81,"discounted_cash":259.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9150","type":"HCPCS"},{"code":"703523313","type":"NDC"}],"standard_charges":[{"gross_charge":1037.81,"discounted_cash":259.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"gross_charge":101.56,"discounted_cash":25.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"31722030625","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"31722030601","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075625","type":"NDC"}],"standard_charges":[{"gross_charge":6.11,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70512084325","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075525","type":"NDC"}],"standard_charges":[{"gross_charge":5.82,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075501","type":"NDC"}],"standard_charges":[{"gross_charge":5.82,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266023425","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"25021018010","type":"NDC"}],"standard_charges":[{"gross_charge":22.41,"discounted_cash":5.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039801","type":"NDC"}],"standard_charges":[{"gross_charge":56.92,"discounted_cash":14.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039841","type":"NDC"}],"standard_charges":[{"gross_charge":23.38,"discounted_cash":5.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"67457086050","type":"NDC"}],"standard_charges":[{"gross_charge":19.95,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"67457086000","type":"NDC"}],"standard_charges":[{"gross_charge":19.95,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"gross_charge":15.27,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"gross_charge":14.43,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"69315084","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":10.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039814","type":"NDC"}],"standard_charges":[{"gross_charge":23.38,"discounted_cash":5.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"62756051240","type":"NDC"}],"standard_charges":[{"gross_charge":14.24,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"62756051244","type":"NDC"}],"standard_charges":[{"gross_charge":14.24,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azithromycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039810","type":"NDC"}],"standard_charges":[{"gross_charge":56.92,"discounted_cash":14.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"74334603","type":"NDC"}],"standard_charges":[{"gross_charge":2941.44,"discounted_cash":735.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"74366303","type":"NDC"}],"standard_charges":[{"gross_charge":39175.46,"discounted_cash":9793.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levOCARNitine per 1 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1955","type":"HCPCS"},{"code":"54482014701","type":"NDC"}],"standard_charges":[{"gross_charge":175.45,"discounted_cash":43.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"74368303","type":"NDC"}],"standard_charges":[{"gross_charge":62244.32,"discounted_cash":15561.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amphotericin B liposome per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0289","type":"HCPCS"},{"code":"469305130","type":"NDC"}],"standard_charges":[{"gross_charge":547.61,"discounted_cash":136.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection,rituximab,10mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005121","type":"NDC"}],"standard_charges":[{"gross_charge":7178.72,"discounted_cash":1794.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection,rituximab,10mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"gross_charge":35893.61,"discounted_cash":8973.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266023401","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611071925","type":"NDC"}],"standard_charges":[{"gross_charge":7.09,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611071901","type":"NDC"}],"standard_charges":[{"gross_charge":7.09,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860070041","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"338006910","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860070002","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"47781058393","type":"NDC"}],"standard_charges":[{"gross_charge":5.97,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"55150021910","type":"NDC"}],"standard_charges":[{"gross_charge":152.28,"discounted_cash":38.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860070001","type":"NDC"}],"standard_charges":[{"gross_charge":13.1,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"409379319","type":"NDC"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"641604125","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"641604101","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"409379301","type":"NDC"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fomepizole per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1451","type":"HCPCS"},{"code":"25021082902","type":"NDC"}],"standard_charges":[{"gross_charge":3806.33,"discounted_cash":951.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fomepizole per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1451","type":"HCPCS"},{"code":"517071001","type":"NDC"}],"standard_charges":[{"gross_charge":3343.25,"discounted_cash":835.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fomepizole per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1451","type":"HCPCS"},{"code":"70710147801","type":"NDC"}],"standard_charges":[{"gross_charge":6351.67,"discounted_cash":1587.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016116","type":"NDC"}],"standard_charges":[{"gross_charge":5.27,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, infliximab, excludes biosimilar, 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"57894016001","type":"NDC"}],"standard_charges":[{"gross_charge":3545.74,"discounted_cash":886.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"67457062910","type":"NDC"}],"standard_charges":[{"gross_charge":117.43,"discounted_cash":29.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"70436016280","type":"NDC"}],"standard_charges":[{"gross_charge":138.95,"discounted_cash":34.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"25021005201","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016502","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016503","type":"NDC"}],"standard_charges":[{"gross_charge":6.32,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"641614625","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"641614601","type":"NDC"}],"standard_charges":[{"gross_charge":4.06,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"641614525","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"641614501","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150023701","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016526","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016516","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042200","type":"NDC"}],"standard_charges":[{"gross_charge":14.13,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexAMETHasone 4 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042300","type":"NDC"}],"standard_charges":[{"gross_charge":5.62,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042254","type":"NDC"}],"standard_charges":[{"gross_charge":14.13,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042010","type":"NDC"}],"standard_charges":[{"gross_charge":28.95,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042000","type":"NDC"}],"standard_charges":[{"gross_charge":28.95,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexAMETHasone 4 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"641036725","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016505","type":"NDC"}],"standard_charges":[{"gross_charge":6.32,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016450","type":"NDC"}],"standard_charges":[{"gross_charge":410.81,"discounted_cash":102.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL (J7060) or 1000 mL (J7070)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"63323062461","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL (J7060) or 1000 mL (J7070)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"63323062474","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL (J7060) or 1000 mL (J7070)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"338001741","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL (J7060) or 1000 mL (J7070)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"338001738","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL (J7060) or 1000 mL (J7070)","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"338001731","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water per 500 mL (J7060) or 1000 mL (J7070)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"264751000","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"63323071100","type":"NDC"}],"standard_charges":[{"gross_charge":436.7,"discounted_cash":109.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"70436012080","type":"NDC"}],"standard_charges":[{"gross_charge":378.56,"discounted_cash":94.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021082850","type":"NDC"}],"standard_charges":[{"gross_charge":572.74,"discounted_cash":143.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"641036721","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323051610","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54818325","type":"NDC"}],"standard_charges":[{"gross_charge":8.42,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"97710202705","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":0.0211,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"97710202605","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"64980050924","type":"NDC"}],"standard_charges":[{"gross_charge":129.4,"discounted_cash":32.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.00211,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54879000308","type":"NDC"}],"standard_charges":[{"gross_charge":208.48,"discounted_cash":52.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323032510","type":"NDC"}],"standard_charges":[{"gross_charge":144.01,"discounted_cash":36.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"65219062210","type":"NDC"}],"standard_charges":[{"gross_charge":137.57,"discounted_cash":34.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"65219062202","type":"NDC"}],"standard_charges":[{"gross_charge":137.57,"discounted_cash":34.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"70436003082","type":"NDC"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":123.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323032503","type":"NDC"}],"standard_charges":[{"gross_charge":144.01,"discounted_cash":36.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"68382004810","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"68382004801","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323032514","type":"NDC"}],"standard_charges":[{"gross_charge":20.84,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"55150015520","type":"NDC"}],"standard_charges":[{"gross_charge":32.63,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"55150015410","type":"NDC"}],"standard_charges":[{"gross_charge":16.39,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"85117701","type":"NDC"}],"standard_charges":[{"gross_charge":1235.86,"discounted_cash":308.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":0.0211,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"97710209205","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54417925","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54817925","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"60505625001","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54418625","type":"NDC"}],"standard_charges":[{"gross_charge":6.57,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"904726761","type":"NDC"}],"standard_charges":[{"gross_charge":7.63,"discounted_cash":1.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"60687072911","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54817525","type":"NDC"}],"standard_charges":[{"gross_charge":5.46,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54418425","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"66993073080","type":"NDC"}],"standard_charges":[{"gross_charge":5.12,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"66993073051","type":"NDC"}],"standard_charges":[{"gross_charge":5.12,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eptifibatide per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"70436002680","type":"NDC"}],"standard_charges":[{"gross_charge":166.99,"discounted_cash":41.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"904726661","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"60687071801","type":"NDC"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"47781091451","type":"NDC"}],"standard_charges":[{"gross_charge":4.89,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"47781091413","type":"NDC"}],"standard_charges":[{"gross_charge":4.89,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"48102004711","type":"NDC"}],"standard_charges":[{"gross_charge":4.34,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"48102004720","type":"NDC"}],"standard_charges":[{"gross_charge":4.34,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54818125","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54818025","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"60687071811","type":"NDC"}],"standard_charges":[{"gross_charge":5.13,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"409662912","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069030101","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069030125","type":"NDC"}],"standard_charges":[{"gross_charge":18.54,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323040124","type":"NDC"}],"standard_charges":[{"gross_charge":192.73,"discounted_cash":48.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323040120","type":"NDC"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":43.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"3256016","type":"NDC"}],"standard_charges":[{"gross_charge":215.51,"discounted_cash":53.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"regadenoson per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"76329332100","type":"NDC"}],"standard_charges":[{"gross_charge":57.99,"discounted_cash":14.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"regadenoson per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"71288020185","type":"NDC"}],"standard_charges":[{"gross_charge":117.04,"discounted_cash":29.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"regadenoson per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"469650189","type":"NDC"}],"standard_charges":[{"gross_charge":1868.81,"discounted_cash":467.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016202","type":"NDC"}],"standard_charges":[{"gross_charge":76.63,"discounted_cash":19.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016203","type":"NDC"}],"standard_charges":[{"gross_charge":76.63,"discounted_cash":19.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611072525","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72611072501","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860070142","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"70860070104","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016226","type":"NDC"}],"standard_charges":[{"gross_charge":6.99,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"409379619","type":"NDC"}],"standard_charges":[{"gross_charge":9.93,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"97710502401","type":"NDC"}],"standard_charges":[{"gross_charge":6.34,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323040101","type":"NDC"}],"standard_charges":[{"gross_charge":174.0,"discounted_cash":43.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ketorolac per 15 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"409379601","type":"NDC"}],"standard_charges":[{"gross_charge":9.93,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"3257016","type":"NDC"}],"standard_charges":[{"gross_charge":431.02,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323040224","type":"NDC"}],"standard_charges":[{"gross_charge":385.46,"discounted_cash":96.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bleomycin per 15 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"703315401","type":"NDC"}],"standard_charges":[{"gross_charge":885.11,"discounted_cash":221.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"169720501","type":"NDC"}],"standard_charges":[{"gross_charge":85253.5,"discounted_cash":21313.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"169721211","type":"NDC"}],"standard_charges":[{"gross_charge":35755.58,"discounted_cash":8938.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"169720201","type":"NDC"}],"standard_charges":[{"gross_charge":35755.58,"discounted_cash":8938.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"betamethasone soluspan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"78206011801","type":"NDC"}],"standard_charges":[{"gross_charge":316.2,"discounted_cash":79.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"betamethasone soluspan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"51754506001","type":"NDC"}],"standard_charges":[{"gross_charge":265.19,"discounted_cash":66.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"betamethasone soluspan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"85432001","type":"NDC"}],"standard_charges":[{"gross_charge":266.57,"discounted_cash":66.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"betamethasone soluspan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"517072001","type":"NDC"}],"standard_charges":[{"gross_charge":269.02,"discounted_cash":67.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"68382086010","type":"NDC"}],"standard_charges":[{"gross_charge":238.15,"discounted_cash":59.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"68382086002","type":"NDC"}],"standard_charges":[{"gross_charge":238.15,"discounted_cash":59.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"143972901","type":"NDC"}],"standard_charges":[{"gross_charge":339.31,"discounted_cash":84.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"17478001202","type":"NDC"}],"standard_charges":[{"gross_charge":278.23,"discounted_cash":69.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"409083011","type":"NDC"}],"standard_charges":[{"gross_charge":365.92,"discounted_cash":91.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"409083001","type":"NDC"}],"standard_charges":[{"gross_charge":365.92,"discounted_cash":91.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323040201","type":"NDC"}],"standard_charges":[{"gross_charge":355.26,"discounted_cash":88.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, aztreonam, 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323040220","type":"NDC"}],"standard_charges":[{"gross_charge":355.26,"discounted_cash":88.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bleomycin per 15 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"61703033218","type":"NDC"}],"standard_charges":[{"gross_charge":194.72,"discounted_cash":48.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bendamustine hcl (treanda), 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9033","type":"HCPCS"},{"code":"63459039120","type":"NDC"}],"standard_charges":[{"gross_charge":23902.19,"discounted_cash":5975.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Octreotide per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037905","type":"NDC"}],"standard_charges":[{"gross_charge":425.92,"discounted_cash":106.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703331101","type":"NDC"}],"standard_charges":[{"gross_charge":27.57,"discounted_cash":6.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037604","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"25021045201","type":"NDC"}],"standard_charges":[{"gross_charge":19.13,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037601","type":"NDC"}],"standard_charges":[{"gross_charge":9.98,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703331104","type":"NDC"}],"standard_charges":[{"gross_charge":27.57,"discounted_cash":6.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"23155068741","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"23155068731","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617410","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617401","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703330101","type":"NDC"}],"standard_charges":[{"gross_charge":9.54,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323036504","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"25021045101","type":"NDC"}],"standard_charges":[{"gross_charge":8.21,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323036501","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703330104","type":"NDC"}],"standard_charges":[{"gross_charge":9.54,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"secretin (human) per 1 mcg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2850","type":"HCPCS"},{"code":"67066000501","type":"NDC"}],"standard_charges":[{"gross_charge":4922.32,"discounted_cash":1230.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617501","type":"NDC"}],"standard_charges":[{"gross_charge":12.11,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Octreotide per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617801","type":"NDC"}],"standard_charges":[{"gross_charge":2086.85,"discounted_cash":521.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617510","type":"NDC"}],"standard_charges":[{"gross_charge":12.11,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037600","type":"NDC"}],"standard_charges":[{"gross_charge":9.98,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"68462089701","type":"NDC"}],"standard_charges":[{"gross_charge":9.54,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037700","type":"NDC"}],"standard_charges":[{"gross_charge":14.01,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"23155068941","type":"NDC"}],"standard_charges":[{"gross_charge":27.19,"discounted_cash":6.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"23155068931","type":"NDC"}],"standard_charges":[{"gross_charge":27.19,"discounted_cash":6.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617610","type":"NDC"}],"standard_charges":[{"gross_charge":38.02,"discounted_cash":9.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617601","type":"NDC"}],"standard_charges":[{"gross_charge":38.02,"discounted_cash":9.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703332101","type":"NDC"}],"standard_charges":[{"gross_charge":44.54,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037704","type":"NDC"}],"standard_charges":[{"gross_charge":15.3,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"25021045301","type":"NDC"}],"standard_charges":[{"gross_charge":14.45,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037701","type":"NDC"}],"standard_charges":[{"gross_charge":14.01,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703332104","type":"NDC"}],"standard_charges":[{"gross_charge":44.54,"discounted_cash":11.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"23155068531","type":"NDC"}],"standard_charges":[{"gross_charge":36.67,"discounted_cash":9.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"641617701","type":"NDC"}],"standard_charges":[{"gross_charge":83.47,"discounted_cash":20.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037805","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703333301","type":"NDC"}],"standard_charges":[{"gross_charge":83.47,"discounted_cash":20.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037641","type":"NDC"}],"standard_charges":[{"gross_charge":10.91,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409141204","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409141210","type":"NDC"}],"standard_charges":[{"gross_charge":29.03,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"641600701","type":"NDC"}],"standard_charges":[{"gross_charge":57.99,"discounted_cash":14.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65145013210","type":"NDC"}],"standard_charges":[{"gross_charge":152.51,"discounted_cash":38.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65145013201","type":"NDC"}],"standard_charges":[{"gross_charge":152.51,"discounted_cash":38.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70594011202","type":"NDC"}],"standard_charges":[{"gross_charge":526.25,"discounted_cash":131.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70594011201","type":"NDC"}],"standard_charges":[{"gross_charge":526.25,"discounted_cash":131.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150045910","type":"NDC"}],"standard_charges":[{"gross_charge":366.13,"discounted_cash":91.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150045901","type":"NDC"}],"standard_charges":[{"gross_charge":366.13,"discounted_cash":91.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71839013710","type":"NDC"}],"standard_charges":[{"gross_charge":297.26,"discounted_cash":74.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71839013701","type":"NDC"}],"standard_charges":[{"gross_charge":297.26,"discounted_cash":74.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70121168001","type":"NDC"}],"standard_charges":[{"gross_charge":2219.69,"discounted_cash":554.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"69784024010","type":"NDC"}],"standard_charges":[{"gross_charge":1140.35,"discounted_cash":285.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"69784024001","type":"NDC"}],"standard_charges":[{"gross_charge":1140.35,"discounted_cash":285.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"43598091958","type":"NDC"}],"standard_charges":[{"gross_charge":1759.23,"discounted_cash":439.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"43598091911","type":"NDC"}],"standard_charges":[{"gross_charge":1759.23,"discounted_cash":439.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"43598069858","type":"NDC"}],"standard_charges":[{"gross_charge":209.53,"discounted_cash":52.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"43598069811","type":"NDC"}],"standard_charges":[{"gross_charge":209.53,"discounted_cash":52.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"niCARdipine in dextrose 100 mcg/mL piggyback 200 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"10122031401","type":"NDC"}],"standard_charges":[{"gross_charge":706.25,"discounted_cash":176.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carboprost 250 mcg/mL solution 1 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9085605","type":"NDC"}],"standard_charges":[{"gross_charge":978.78,"discounted_cash":244.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"10122031301","type":"NDC"}],"standard_charges":[{"gross_charge":346.23,"discounted_cash":86.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143963401","type":"NDC"}],"standard_charges":[{"gross_charge":235.93,"discounted_cash":58.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"52565005310","type":"NDC"}],"standard_charges":[{"gross_charge":248.83,"discounted_cash":62.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"52565005301","type":"NDC"}],"standard_charges":[{"gross_charge":248.83,"discounted_cash":62.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323038620","type":"NDC"}],"standard_charges":[{"gross_charge":160.88,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"121097655","type":"NDC"}],"standard_charges":[{"gross_charge":72.1,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"121097610","type":"NDC"}],"standard_charges":[{"gross_charge":72.1,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323038501","type":"NDC"}],"standard_charges":[{"gross_charge":80.48,"discounted_cash":20.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"52565005210","type":"NDC"}],"standard_charges":[{"gross_charge":128.3,"discounted_cash":32.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"52565005201","type":"NDC"}],"standard_charges":[{"gross_charge":128.3,"discounted_cash":32.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323038510","type":"NDC"}],"standard_charges":[{"gross_charge":80.48,"discounted_cash":20.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefotaxime per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0698","type":"HCPCS"},{"code":"143993010","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefotaxime per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0698","type":"HCPCS"},{"code":"143993001","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefotaxime 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0698","type":"HCPCS"},{"code":"143993125","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefotaxime 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0698","type":"HCPCS"},{"code":"143993101","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"43066002610","type":"NDC"}],"standard_charges":[{"gross_charge":346.23,"discounted_cash":86.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"43066000910","type":"NDC"}],"standard_charges":[{"gross_charge":363.08,"discounted_cash":90.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"10122031310","type":"NDC"}],"standard_charges":[{"gross_charge":346.23,"discounted_cash":86.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitoxantrone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9293","type":"HCPCS"},{"code":"63323013210","type":"NDC"}],"standard_charges":[{"gross_charge":705.1,"discounted_cash":176.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitoxantrone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9293","type":"HCPCS"},{"code":"61703034365","type":"NDC"}],"standard_charges":[{"gross_charge":1563.5,"discounted_cash":390.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitoxantrone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9293","type":"HCPCS"},{"code":"61703034318","type":"NDC"}],"standard_charges":[{"gross_charge":1250.72,"discounted_cash":312.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70748032301","type":"NDC"}],"standard_charges":[{"gross_charge":26.53,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"68462047054","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"68462047040","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"68462046940","type":"NDC"}],"standard_charges":[{"gross_charge":11.92,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72205010207","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72205010201","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72205010107","type":"NDC"}],"standard_charges":[{"gross_charge":9.44,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72205010101","type":"NDC"}],"standard_charges":[{"gross_charge":9.44,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860040641","type":"NDC"}],"standard_charges":[{"gross_charge":23.67,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860040541","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860040504","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860040610","type":"NDC"}],"standard_charges":[{"gross_charge":23.67,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409141240","type":"NDC"}],"standard_charges":[{"gross_charge":29.03,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409141234","type":"NDC"}],"standard_charges":[{"gross_charge":14.25,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"641600801","type":"NDC"}],"standard_charges":[{"gross_charge":51.63,"discounted_cash":12.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bumetanide, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70748032310","type":"NDC"}],"standard_charges":[{"gross_charge":26.53,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"409434835","type":"NDC"}],"standard_charges":[{"gross_charge":9.97,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":0.16667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015318","type":"NDC"}],"standard_charges":[{"gross_charge":16.38,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"143987510","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitoxantrone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9293","type":"HCPCS"},{"code":"703468501","type":"NDC"}],"standard_charges":[{"gross_charge":3122.52,"discounted_cash":780.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"romiplostim per 10 mcg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55513022201","type":"NDC"}],"standard_charges":[{"gross_charge":42066.5,"discounted_cash":10516.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"romiPLOStim per 10 mcg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55513022101","type":"NDC"}],"standard_charges":[{"gross_charge":21033.29,"discounted_cash":5258.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitriol per 0.1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0636","type":"HCPCS"},{"code":"72266025110","type":"NDC"}],"standard_charges":[{"gross_charge":47.45,"discounted_cash":11.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitriol per 0.1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0636","type":"HCPCS"},{"code":"72266025101","type":"NDC"}],"standard_charges":[{"gross_charge":47.45,"discounted_cash":11.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitriol per 0.1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0636","type":"HCPCS"},{"code":"17478093101","type":"NDC"}],"standard_charges":[{"gross_charge":46.34,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409176110","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":10.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"70700016922","type":"NDC"}],"standard_charges":[{"gross_charge":49.02,"discounted_cash":12.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409176105","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":10.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409361301","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323061601","type":"NDC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"55150018003","type":"NDC"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"143987525","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"143987501","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015300","type":"NDC"}],"standard_charges":[{"gross_charge":35.8,"discounted_cash":8.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409176102","type":"NDC"}],"standard_charges":[{"gross_charge":30.87,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"72485021102","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"45963061481","type":"NDC"}],"standard_charges":[{"gross_charge":50.79,"discounted_cash":12.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"60505612800","type":"NDC"}],"standard_charges":[{"gross_charge":50.48,"discounted_cash":12.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer 800 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0601","type":"HCPCS"},{"code":"17856005803","type":"NDC"}],"standard_charges":[{"gross_charge":8.47,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer 800 mg tablet 270 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0601","type":"HCPCS"},{"code":"65162005827","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer 800 mg tablet 270 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0601","type":"HCPCS"},{"code":"115130927","type":"NDC"}],"standard_charges":[{"gross_charge":8.67,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer 800 mg tablet 270 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0601","type":"HCPCS"},{"code":"58468013001","type":"NDC"}],"standard_charges":[{"gross_charge":24.23,"discounted_cash":6.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 40 mg/mL suspension 1 mL Vial","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3300","type":"HCPCS"},{"code":"78089778","type":"NDC"}],"standard_charges":[{"gross_charge":721.3,"discounted_cash":180.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 40 mg/mL suspension 1 mL Vial","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3300","type":"HCPCS"},{"code":"65054301","type":"NDC"}],"standard_charges":[{"gross_charge":673.93,"discounted_cash":168.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ixabepilone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9207","type":"HCPCS"},{"code":"70020191102","type":"NDC"}],"standard_charges":[{"gross_charge":46178.85,"discounted_cash":11544.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ixabepilone per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9207","type":"HCPCS"},{"code":"70020191101","type":"NDC"}],"standard_charges":[{"gross_charge":46178.85,"discounted_cash":11544.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ixabepilone 15 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9207","type":"HCPCS"},{"code":"70020191002","type":"NDC"}],"standard_charges":[{"gross_charge":15392.92,"discounted_cash":3848.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ixabepilone 15 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9207","type":"HCPCS"},{"code":"70020191001","type":"NDC"}],"standard_charges":[{"gross_charge":15392.92,"discounted_cash":3848.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lanreotide 60 mg/0.2 mL syringe 0.2 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"},{"code":"15054106004","type":"NDC"}],"standard_charges":[{"gross_charge":46517.49,"discounted_cash":11629.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010365","type":"NDC"}],"standard_charges":[{"gross_charge":497.9,"discounted_cash":124.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010364","type":"NDC"}],"standard_charges":[{"gross_charge":637.31,"discounted_cash":159.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010351","type":"NDC"}],"standard_charges":[{"gross_charge":286.87,"discounted_cash":71.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"72266025301","type":"NDC"}],"standard_charges":[{"gross_charge":245.12,"discounted_cash":61.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer 800 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0601","type":"HCPCS"},{"code":"17856092101","type":"NDC"}],"standard_charges":[{"gross_charge":8.43,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"25021025351","type":"NDC"}],"standard_charges":[{"gross_charge":114.9,"discounted_cash":28.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer 800 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0601","type":"HCPCS"},{"code":"50268072011","type":"NDC"}],"standard_charges":[{"gross_charge":7.08,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer 800 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0601","type":"HCPCS"},{"code":"904670706","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516521601","type":"NDC"}],"standard_charges":[{"gross_charge":248.57,"discounted_cash":62.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"944049301","type":"NDC"}],"standard_charges":[{"gross_charge":241.29,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323065189","type":"NDC"}],"standard_charges":[{"gross_charge":234.2,"discounted_cash":58.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323065121","type":"NDC"}],"standard_charges":[{"gross_charge":234.2,"discounted_cash":58.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"25021030167","type":"NDC"}],"standard_charges":[{"gross_charge":61.63,"discounted_cash":15.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"43547063201","type":"NDC"}],"standard_charges":[{"gross_charge":75.99,"discounted_cash":19.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"71288016610","type":"NDC"}],"standard_charges":[{"gross_charge":115.21,"discounted_cash":28.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"55150038101","type":"NDC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":36.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"50742034001","type":"NDC"}],"standard_charges":[{"gross_charge":316.2,"discounted_cash":79.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"43598038662","type":"NDC"}],"standard_charges":[{"gross_charge":108.77,"discounted_cash":27.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9296","type":"HCPCS"},{"code":"16729022903","type":"NDC"}],"standard_charges":[{"gross_charge":100.81,"discounted_cash":25.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMEtrexed per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"2764001","type":"NDC"}],"standard_charges":[{"gross_charge":6039.07,"discounted_cash":1509.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer 800 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0601","type":"HCPCS"},{"code":"904670782","type":"NDC"}],"standard_charges":[{"gross_charge":18.19,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer 800 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0601","type":"HCPCS"},{"code":"50268072015","type":"NDC"}],"standard_charges":[{"gross_charge":7.08,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"25021025350","type":"NDC"}],"standard_charges":[{"gross_charge":57.45,"discounted_cash":14.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"60505627700","type":"NDC"}],"standard_charges":[{"gross_charge":229.8,"discounted_cash":57.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"143950501","type":"NDC"}],"standard_charges":[{"gross_charge":218.31,"discounted_cash":54.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"67457051625","type":"NDC"}],"standard_charges":[{"gross_charge":14.83,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"69600102","type":"NDC"}],"standard_charges":[{"gross_charge":293.12,"discounted_cash":73.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"641613601","type":"NDC"}],"standard_charges":[{"gross_charge":14.51,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040302","type":"NDC"}],"standard_charges":[{"gross_charge":130.45,"discounted_cash":32.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040304","type":"NDC"}],"standard_charges":[{"gross_charge":432.64,"discounted_cash":108.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"64679073002","type":"NDC"}],"standard_charges":[{"gross_charge":112.45,"discounted_cash":28.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"64679073001","type":"NDC"}],"standard_charges":[{"gross_charge":112.45,"discounted_cash":28.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"69600110","type":"NDC"}],"standard_charges":[{"gross_charge":879.37,"discounted_cash":219.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"641613701","type":"NDC"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":21.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040310","type":"NDC"}],"standard_charges":[{"gross_charge":432.64,"discounted_cash":108.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epirubicin per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9178","type":"HCPCS"},{"code":"45963060868","type":"NDC"}],"standard_charges":[{"gross_charge":352.17,"discounted_cash":88.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epirubicin per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9178","type":"HCPCS"},{"code":"59923070125","type":"NDC"}],"standard_charges":[{"gross_charge":352.17,"discounted_cash":88.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epirubicin per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9178","type":"HCPCS"},{"code":"9509101","type":"NDC"}],"standard_charges":[{"gross_charge":242.06,"discounted_cash":60.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epirubicin per 2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9178","type":"HCPCS"},{"code":"66758004201","type":"NDC"}],"standard_charges":[{"gross_charge":919.2,"discounted_cash":229.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ifosfamide per 1 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"703342911","type":"NDC"}],"standard_charges":[{"gross_charge":831.88,"discounted_cash":207.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"67457051600","type":"NDC"}],"standard_charges":[{"gross_charge":14.83,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosphenytoin per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"63323040301","type":"NDC"}],"standard_charges":[{"gross_charge":130.45,"discounted_cash":32.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDArubicin per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9211","type":"HCPCS"},{"code":"13258691","type":"NDC"}],"standard_charges":[{"gross_charge":550.52,"discounted_cash":137.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDArubicin per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9211","type":"HCPCS"},{"code":"13259691","type":"NDC"}],"standard_charges":[{"gross_charge":1126.02,"discounted_cash":281.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"143950401","type":"NDC"}],"standard_charges":[{"gross_charge":117.58,"discounted_cash":29.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"70860020651","type":"NDC"}],"standard_charges":[{"gross_charge":135.58,"discounted_cash":33.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729028838","type":"NDC"}],"standard_charges":[{"gross_charge":222.14,"discounted_cash":55.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729028811","type":"NDC"}],"standard_charges":[{"gross_charge":118.35,"discounted_cash":29.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"68001028333","type":"NDC"}],"standard_charges":[{"gross_charge":152.43,"discounted_cash":38.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"68001028327","type":"NDC"}],"standard_charges":[{"gross_charge":252.78,"discounted_cash":63.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"68001028324","type":"NDC"}],"standard_charges":[{"gross_charge":252.78,"discounted_cash":63.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68982064301","type":"NDC"}],"standard_charges":[{"gross_charge":252.4,"discounted_cash":63.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"67457042551","type":"NDC"}],"standard_charges":[{"gross_charge":149.75,"discounted_cash":37.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"44567051001","type":"NDC"}],"standard_charges":[{"gross_charge":149.37,"discounted_cash":37.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"44567050901","type":"NDC"}],"standard_charges":[{"gross_charge":83.11,"discounted_cash":20.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"703574811","type":"NDC"}],"standard_charges":[{"gross_charge":308.7,"discounted_cash":77.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"703574711","type":"NDC"}],"standard_charges":[{"gross_charge":169.29,"discounted_cash":42.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDArubicin per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9211","type":"HCPCS"},{"code":"143921901","type":"NDC"}],"standard_charges":[{"gross_charge":1759.5,"discounted_cash":439.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDArubicin per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9211","type":"HCPCS"},{"code":"703415611","type":"NDC"}],"standard_charges":[{"gross_charge":824.06,"discounted_cash":206.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDArubicin per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9211","type":"HCPCS"},{"code":"703415511","type":"NDC"}],"standard_charges":[{"gross_charge":1261.68,"discounted_cash":315.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"67457042410","type":"NDC"}],"standard_charges":[{"gross_charge":299.51,"discounted_cash":74.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323038601","type":"NDC"}],"standard_charges":[{"gross_charge":160.88,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"44206025190","type":"NDC"}],"standard_charges":[{"gross_charge":252.4,"discounted_cash":63.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"76125079225","type":"NDC"}],"standard_charges":[{"gross_charge":283.42,"discounted_cash":70.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis B immune globulin per 1 mL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"69800420301","type":"NDC"}],"standard_charges":[{"gross_charge":922.25,"discounted_cash":230.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis A vaccine 50 unit/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"6409602","type":"NDC"}],"standard_charges":[{"gross_charge":519.78,"discounted_cash":129.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis A vaccine 50 unit/mL syringe 1 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"6409601","type":"NDC"}],"standard_charges":[{"gross_charge":519.78,"discounted_cash":129.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"49001483","type":"NDC"}],"standard_charges":[{"gross_charge":103.83,"discounted_cash":25.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"44567015010","type":"NDC"}],"standard_charges":[{"gross_charge":22.56,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"71288000631","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":18.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"66794020741","type":"NDC"}],"standard_charges":[{"gross_charge":111.54,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"66794020702","type":"NDC"}],"standard_charges":[{"gross_charge":111.54,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"71288000630","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":18.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021018730","type":"NDC"}],"standard_charges":[{"gross_charge":62.72,"discounted_cash":15.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"67457034910","type":"NDC"}],"standard_charges":[{"gross_charge":111.54,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"67457034903","type":"NDC"}],"standard_charges":[{"gross_charge":111.54,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"49001481","type":"NDC"}],"standard_charges":[{"gross_charge":103.83,"discounted_cash":25.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"44567021110","type":"NDC"}],"standard_charges":[{"gross_charge":22.91,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011720","type":"NDC"}],"standard_charges":[{"gross_charge":35.44,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis B immune globulin per 1 mL","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"59730420301","type":"NDC"}],"standard_charges":[{"gross_charge":703.82,"discounted_cash":175.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"641611710","type":"NDC"}],"standard_charges":[{"gross_charge":40.06,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"61703034909","type":"NDC"}],"standard_charges":[{"gross_charge":122.94,"discounted_cash":30.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"143970101","type":"NDC"}],"standard_charges":[{"gross_charge":100.81,"discounted_cash":25.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"703443281","type":"NDC"}],"standard_charges":[{"gross_charge":50.56,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"45963061451","type":"NDC"}],"standard_charges":[{"gross_charge":206.74,"discounted_cash":51.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"63323019352","type":"NDC"}],"standard_charges":[{"gross_charge":142.63,"discounted_cash":35.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"59923070202","type":"NDC"}],"standard_charges":[{"gross_charge":48.95,"discounted_cash":12.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"9752904","type":"NDC"}],"standard_charges":[{"gross_charge":194.87,"discounted_cash":48.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"703443211","type":"NDC"}],"standard_charges":[{"gross_charge":50.56,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"70700017022","type":"NDC"}],"standard_charges":[{"gross_charge":87.17,"discounted_cash":21.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"72485021205","type":"NDC"}],"standard_charges":[{"gross_charge":49.87,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"45963061485","type":"NDC"}],"standard_charges":[{"gross_charge":84.18,"discounted_cash":21.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"60505612801","type":"NDC"}],"standard_charges":[{"gross_charge":94.83,"discounted_cash":23.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"703443481","type":"NDC"}],"standard_charges":[{"gross_charge":93.15,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"45963061455","type":"NDC"}],"standard_charges":[{"gross_charge":135.58,"discounted_cash":33.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"25021023005","type":"NDC"}],"standard_charges":[{"gross_charge":96.06,"discounted_cash":24.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"63323019355","type":"NDC"}],"standard_charges":[{"gross_charge":307.01,"discounted_cash":76.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"59923070205","type":"NDC"}],"standard_charges":[{"gross_charge":144.62,"discounted_cash":36.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"9752903","type":"NDC"}],"standard_charges":[{"gross_charge":152.82,"discounted_cash":38.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"641611701","type":"NDC"}],"standard_charges":[{"gross_charge":40.06,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021014330","type":"NDC"}],"standard_charges":[{"gross_charge":63.8,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"63323036920","type":"NDC"}],"standard_charges":[{"gross_charge":67.92,"discounted_cash":16.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031091","type":"NDC"}],"standard_charges":[{"gross_charge":229.8,"discounted_cash":57.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68982062302","type":"NDC"}],"standard_charges":[{"gross_charge":310.23,"discounted_cash":77.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"76125079026","type":"NDC"}],"standard_charges":[{"gross_charge":283.42,"discounted_cash":70.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"76125079025","type":"NDC"}],"standard_charges":[{"gross_charge":279.59,"discounted_cash":69.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"944049505","type":"NDC"}],"standard_charges":[{"gross_charge":241.29,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521403","type":"NDC"}],"standard_charges":[{"gross_charge":248.95,"discounted_cash":62.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031090","type":"NDC"}],"standard_charges":[{"gross_charge":252.78,"discounted_cash":63.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521401","type":"NDC"}],"standard_charges":[{"gross_charge":248.95,"discounted_cash":62.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"13533068525","type":"NDC"}],"standard_charges":[{"gross_charge":315.98,"discounted_cash":79.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9041","type":"HCPCS"},{"code":"13533068520","type":"NDC"}],"standard_charges":[{"gross_charge":1093.47,"discounted_cash":273.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"44206025105","type":"NDC"}],"standard_charges":[{"gross_charge":252.4,"discounted_cash":63.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"53768032","type":"NDC"}],"standard_charges":[{"gross_charge":257.76,"discounted_cash":64.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"944049303","type":"NDC"}],"standard_charges":[{"gross_charge":241.29,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516521607","type":"NDC"}],"standard_charges":[{"gross_charge":304.1,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"76125079226","type":"NDC"}],"standard_charges":[{"gross_charge":283.42,"discounted_cash":70.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9041","type":"HCPCS"},{"code":"68516521405","type":"NDC"}],"standard_charges":[{"gross_charge":940.27,"discounted_cash":235.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9041","type":"HCPCS"},{"code":"68516521406","type":"NDC"}],"standard_charges":[{"gross_charge":940.27,"discounted_cash":235.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521800","type":"NDC"}],"standard_charges":[{"gross_charge":248.95,"discounted_cash":62.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521804","type":"NDC"}],"standard_charges":[{"gross_charge":248.95,"discounted_cash":62.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"66794020602","type":"NDC"}],"standard_charges":[{"gross_charge":59.07,"discounted_cash":14.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"67457034815","type":"NDC"}],"standard_charges":[{"gross_charge":21.38,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"49001381","type":"NDC"}],"standard_charges":[{"gross_charge":54.91,"discounted_cash":13.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"44567021010","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"gross_charge":46.35,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"641611610","type":"NDC"}],"standard_charges":[{"gross_charge":22.41,"discounted_cash":5.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"641611601","type":"NDC"}],"standard_charges":[{"gross_charge":22.41,"discounted_cash":5.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516521603","type":"NDC"}],"standard_charges":[{"gross_charge":248.57,"discounted_cash":62.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021014220","type":"NDC"}],"standard_charges":[{"gross_charge":29.18,"discounted_cash":7.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alprostadil per 1.25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"703150101","type":"NDC"}],"standard_charges":[{"gross_charge":838.19,"discounted_cash":209.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alprostadil per 1.25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"703150102","type":"NDC"}],"standard_charges":[{"gross_charge":838.19,"discounted_cash":209.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alprostadil per 1.25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"9316901","type":"NDC"}],"standard_charges":[{"gross_charge":1096.48,"discounted_cash":274.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alprostadil per 1.25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"9316906","type":"NDC"}],"standard_charges":[{"gross_charge":1096.48,"discounted_cash":274.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031050","type":"NDC"}],"standard_charges":[{"gross_charge":229.8,"discounted_cash":57.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031025","type":"NDC"}],"standard_charges":[{"gross_charge":252.78,"discounted_cash":63.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albumin human per 12.5 g (P9045) or 2.5 g (P9041) or 12.5 g (P9045)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"944049506","type":"NDC"}],"standard_charges":[{"gross_charge":241.29,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin-sulbactam per 1.5 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"63323036820","type":"NDC"}],"standard_charges":[{"gross_charge":34.27,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"121097755","type":"NDC"}],"standard_charges":[{"gross_charge":137.76,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefoTEtan 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"121097710","type":"NDC"}],"standard_charges":[{"gross_charge":137.76,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefOXitin 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"63323034129","type":"NDC"}],"standard_charges":[{"gross_charge":19.75,"discounted_cash":4.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"703398501","type":"NDC"}],"standard_charges":[{"gross_charge":373.43,"discounted_cash":93.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676030400","type":"NDC"}],"standard_charges":[{"gross_charge":760.75,"discounted_cash":190.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513012610","type":"NDC"}],"standard_charges":[{"gross_charge":245.17,"discounted_cash":61.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513012601","type":"NDC"}],"standard_charges":[{"gross_charge":245.17,"discounted_cash":61.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676030200","type":"NDC"}],"standard_charges":[{"gross_charge":380.41,"discounted_cash":95.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676031002","type":"NDC"}],"standard_charges":[{"gross_charge":1248.68,"discounted_cash":312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676031001","type":"NDC"}],"standard_charges":[{"gross_charge":1248.68,"discounted_cash":312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513014410","type":"NDC"}],"standard_charges":[{"gross_charge":1225.89,"discounted_cash":306.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513014401","type":"NDC"}],"standard_charges":[{"gross_charge":1225.89,"discounted_cash":306.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676031000","type":"NDC"}],"standard_charges":[{"gross_charge":1248.68,"discounted_cash":312.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"70436020382","type":"NDC"}],"standard_charges":[{"gross_charge":30.49,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"70436020380","type":"NDC"}],"standard_charges":[{"gross_charge":33.09,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"143914110","type":"NDC"}],"standard_charges":[{"gross_charge":89.47,"discounted_cash":22.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"143914101","type":"NDC"}],"standard_charges":[{"gross_charge":89.47,"discounted_cash":22.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021023310","type":"NDC"}],"standard_charges":[{"gross_charge":108.77,"discounted_cash":27.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"409234468","type":"NDC"}],"standard_charges":[{"gross_charge":39.99,"discounted_cash":10.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"67457046910","type":"NDC"}],"standard_charges":[{"gross_charge":106.93,"discounted_cash":26.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"955172510","type":"NDC"}],"standard_charges":[{"gross_charge":243.59,"discounted_cash":60.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505613207","type":"NDC"}],"standard_charges":[{"gross_charge":259.37,"discounted_cash":64.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"63323075020","type":"NDC"}],"standard_charges":[{"gross_charge":1378.95,"discounted_cash":344.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"955173320","type":"NDC"}],"standard_charges":[{"gross_charge":209.58,"discounted_cash":52.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"955172720","type":"NDC"}],"standard_charges":[{"gross_charge":766.15,"discounted_cash":191.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021023320","type":"NDC"}],"standard_charges":[{"gross_charge":217.54,"discounted_cash":54.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"67457044220","type":"NDC"}],"standard_charges":[{"gross_charge":213.87,"discounted_cash":53.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"61703036322","type":"NDC"}],"standard_charges":[{"gross_charge":657.99,"discounted_cash":164.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288014995","type":"NDC"}],"standard_charges":[{"gross_charge":49.87,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"50742040510","type":"NDC"}],"standard_charges":[{"gross_charge":192.5,"discounted_cash":48.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"16729033203","type":"NDC"}],"standard_charges":[{"gross_charge":65.65,"discounted_cash":16.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"43066001401","type":"NDC"}],"standard_charges":[{"gross_charge":78.52,"discounted_cash":19.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288010110","type":"NDC"}],"standard_charges":[{"gross_charge":50.79,"discounted_cash":12.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505613206","type":"NDC"}],"standard_charges":[{"gross_charge":75.3,"discounted_cash":18.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"955173110","type":"NDC"}],"standard_charges":[{"gross_charge":126.85,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"63323075010","type":"NDC"}],"standard_charges":[{"gross_charge":792.81,"discounted_cash":198.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"781331570","type":"NDC"}],"standard_charges":[{"gross_charge":71.47,"discounted_cash":17.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"409234462","type":"NDC"}],"standard_charges":[{"gross_charge":46.57,"discounted_cash":11.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"409202520","type":"NDC"}],"standard_charges":[{"gross_charge":32.63,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"409234401","type":"NDC"}],"standard_charges":[{"gross_charge":51.78,"discounted_cash":12.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.9 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"97710523405","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.9 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338979912","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.9 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338979901","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.9 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338008904","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.9 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338008903","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.9 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"264761000","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"60739000","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"97710523505","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"63323086910","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"990792609","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338008504","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338008503","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium choride 0.45 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"264761200","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.2 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338007704","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.2 % per 500 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"338007703","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouraciL 5 gram/100 mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"16729027638","type":"NDC"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":113.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouraciL 5 gram/100 mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011768","type":"NDC"}],"standard_charges":[{"gross_charge":108.01,"discounted_cash":27.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouraciL 5 gram/100 mL solution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"25021021599","type":"NDC"}],"standard_charges":[{"gross_charge":104.94,"discounted_cash":26.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouraciL 5 gram/100 mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018922","type":"NDC"}],"standard_charges":[{"gross_charge":561.48,"discounted_cash":140.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"409234402","type":"NDC"}],"standard_charges":[{"gross_charge":46.57,"discounted_cash":11.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dimercaproL 100 mg/mL solution 3 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0470","type":"HCPCS"},{"code":"17478052603","type":"NDC"}],"standard_charges":[{"gross_charge":989.15,"discounted_cash":247.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dihydroergotamine per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"81284041110","type":"NDC"}],"standard_charges":[{"gross_charge":144.64,"discounted_cash":36.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dihydroergotamine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"81284041100","type":"NDC"}],"standard_charges":[{"gross_charge":340.76,"discounted_cash":85.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dihydroergotamine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"61990041101","type":"NDC"}],"standard_charges":[{"gross_charge":356.47,"discounted_cash":89.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dihydroergotamine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"61990041100","type":"NDC"}],"standard_charges":[{"gross_charge":356.47,"discounted_cash":89.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dihydroergotamine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"143927310","type":"NDC"}],"standard_charges":[{"gross_charge":355.08,"discounted_cash":88.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"51991092398","type":"NDC"}],"standard_charges":[{"gross_charge":276.83,"discounted_cash":69.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dihydroergotamine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"143927301","type":"NDC"}],"standard_charges":[{"gross_charge":355.08,"discounted_cash":88.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dihydroergotamine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"574085010","type":"NDC"}],"standard_charges":[{"gross_charge":1087.9,"discounted_cash":271.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"70515026310","type":"NDC"}],"standard_charges":[{"gross_charge":793.11,"discounted_cash":198.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"70515026210","type":"NDC"}],"standard_charges":[{"gross_charge":983.27,"discounted_cash":245.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferumoxytol per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"781315401","type":"NDC"}],"standard_charges":[{"gross_charge":1789.35,"discounted_cash":447.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferumoxytol per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":8653.9,"discounted_cash":2163.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouraciL 5 gram/100 mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011761","type":"NDC"}],"standard_charges":[{"gross_charge":898.52,"discounted_cash":224.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouraciL 5 gram/100 mL solution 100 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"71288015476","type":"NDC"}],"standard_charges":[{"gross_charge":170.82,"discounted_cash":42.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dihydroergotamine per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1110","type":"HCPCS"},{"code":"574085005","type":"NDC"}],"standard_charges":[{"gross_charge":484.77,"discounted_cash":121.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.45 % with KCl 40 mEq/L 40 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338067504","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288010120","type":"NDC"}],"standard_charges":[{"gross_charge":119.8,"discounted_cash":29.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"16729033205","type":"NDC"}],"standard_charges":[{"gross_charge":127.77,"discounted_cash":31.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Gallium GA-67 citrate, diagnostic, per millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9556","type":"HCPCS"},{"code":"69945018012","type":"NDC"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":90.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9561","type":"HCPCS"},{"code":"69945009120","type":"NDC"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":96.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9562","type":"HCPCS"},{"code":"69945009620","type":"NDC"}],"standard_charges":[{"gross_charge":2190.0,"discounted_cash":547.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9560","type":"HCPCS"},{"code":"69945006820","type":"NDC"}],"standard_charges":[{"gross_charge":1266.0,"discounted_cash":316.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9521","type":"HCPCS"},{"code":"17156002205","type":"NDC"}],"standard_charges":[{"gross_charge":9396.0,"discounted_cash":2349.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9520","type":"HCPCS"},{"code":"65857042505","type":"NDC"}],"standard_charges":[{"gross_charge":4785.78,"discounted_cash":1196.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Fluciclovine f-18, diagnostic, 1 millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9588","type":"HCPCS"},{"code":"69932000130","type":"NDC"}],"standard_charges":[{"gross_charge":3099.9,"discounted_cash":774.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"HC GALLIUM GA-68 DOTATATE NETSPOT DIAGNOSTIC 0.1 MILLICURIE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9587","type":"HCPCS"},{"code":"69488000140","type":"NDC"}],"standard_charges":[{"gross_charge":3600.0,"discounted_cash":900.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9552","type":"HCPCS"},{"code":"40028051130","type":"NDC"}],"standard_charges":[{"gross_charge":732.0,"discounted_cash":183.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Indium IN-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9572","type":"HCPCS"},{"code":"69945005040","type":"NDC"}],"standard_charges":[{"gross_charge":38556.0,"discounted_cash":9639.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m medronate, diagnostic, per study dose, up to 30 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9503","type":"HCPCS"},{"code":"65174066030","type":"NDC"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium tc-99m sestamibi, diagnostic, per study dose","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"},{"code":"45548014110","type":"NDC"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"},{"code":"45567003001","type":"NDC"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":202.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"},{"code":"270008320","type":"NDC"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":49.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Florbetapir f18, diagnostic, per study dose, up to 10 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9586","type":"HCPCS"},{"code":"2120001","type":"NDC"}],"standard_charges":[{"gross_charge":18174.0,"discounted_cash":4543.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9580","type":"HCPCS"},{"code":"40028051230","type":"NDC"}],"standard_charges":[{"gross_charge":732.0,"discounted_cash":183.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Indium IN-111 pentetate, diagnostic, per 0.5 millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9548","type":"HCPCS"},{"code":"17156025108","type":"NDC"}],"standard_charges":[{"gross_charge":14700.0,"discounted_cash":3675.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"Copper cu-64, dotatate, diagnostic, 1 millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9592","type":"HCPCS"},{"code":"69945006401","type":"NDC"}],"standard_charges":[{"gross_charge":6225.0,"discounted_cash":1556.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9800","type":"HCPCS"},{"code":"69488001761","type":"NDC"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":1236.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"gadobenate dimeglumine per 1 mL","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"270516412","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"balanced salt soln no.1 irrig. solution 500 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"271","type":"RC"},{"code":"65080050","type":"NDC"}],"standard_charges":[{"gross_charge":448.11,"discounted_cash":112.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"balanced salt ophthalmic solution solution 15 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"271","type":"RC"},{"code":"65079515","type":"NDC"}],"standard_charges":[{"gross_charge":27.35,"discounted_cash":6.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"purified water irrigation solution 30 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"271","type":"RC"},{"code":"65053001","type":"NDC"}],"standard_charges":[{"gross_charge":106.34,"discounted_cash":26.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium tc-99m tetrofosmin, diagnostic, per study dose","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9502","type":"HCPCS"},{"code":"17156002405","type":"NDC"}],"standard_charges":[{"gross_charge":592.98,"discounted_cash":148.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m succimer, diagnostic, per study dose, up to 10 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9551","type":"HCPCS"},{"code":"71083002005","type":"NDC"}],"standard_charges":[{"gross_charge":10692.0,"discounted_cash":2673.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Iodine I-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9516","type":"HCPCS"},{"code":"69945060220","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MICROCURIE"}]},{"description":"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9570","type":"HCPCS"},{"code":"17156002101","type":"NDC"}],"standard_charges":[{"gross_charge":10432.8,"discounted_cash":2608.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9582","type":"HCPCS"},{"code":"17156023501","type":"NDC"}],"standard_charges":[{"gross_charge":34080.0,"discounted_cash":8520.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m pertechnetate, diagnostic, per millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9512","type":"HCPCS"},{"code":"99999408400","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"Technetium Tc-99m pertechnetate, diagnostic, per millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9540","type":"HCPCS"},{"code":"99999408400","type":"NDC"}],"standard_charges":[{"gross_charge":831.12,"discounted_cash":207.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m pertechnetate, diagnostic, per millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"},{"code":"99999408400","type":"NDC"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":202.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9538","type":"HCPCS"},{"code":"69945009420","type":"NDC"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":96.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Flotufolastat F18, diagnostic, 1 millicurie (POSLUMA)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9608","type":"HCPCS"},{"code":"69932000201","type":"NDC"}],"standard_charges":[{"gross_charge":3799.38,"discounted_cash":949.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"Piflufolastat f-18, diagnostic, 1 millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"71258002200","type":"NDC"}],"standard_charges":[{"gross_charge":3690.36,"discounted_cash":922.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"Fluoroestradiol f 18, diagnostic, 1 millicurie","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9591","type":"HCPCS"},{"code":"72874000101","type":"NDC"}],"standard_charges":[{"gross_charge":7337.28,"discounted_cash":1834.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"Technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9567","type":"HCPCS"},{"code":"65174028830","type":"NDC"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":204.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"343","type":"RC"},{"code":"A9584","type":"HCPCS"},{"code":"17156021001","type":"NDC"}],"standard_charges":[{"gross_charge":11506.2,"discounted_cash":2876.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water solution 1,000 mL Bottle","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"990713909","type":"NDC"}],"standard_charges":[{"gross_charge":32.97,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethacrynic acid 50 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42023015701","type":"NDC"}],"standard_charges":[{"gross_charge":4038.35,"discounted_cash":1009.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethacrynic acid 50 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25010021027","type":"NDC"}],"standard_charges":[{"gross_charge":35800.24,"discounted_cash":8950.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"conjugated estrogens per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1410","type":"HCPCS"},{"code":"46074905","type":"NDC"}],"standard_charges":[{"gross_charge":2732.48,"discounted_cash":683.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer carbonate 2.4 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0602","type":"HCPCS"},{"code":"43598047901","type":"NDC"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":9.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer carbonate 2.4 gram powder in packet 90 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0602","type":"HCPCS"},{"code":"43598047990","type":"NDC"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":9.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer carbonate 2.4 gram powder in packet 90 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0602","type":"HCPCS"},{"code":"955105490","type":"NDC"}],"standard_charges":[{"gross_charge":25.59,"discounted_cash":6.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer carbonate 2.4 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0602","type":"HCPCS"},{"code":"955105401","type":"NDC"}],"standard_charges":[{"gross_charge":25.59,"discounted_cash":6.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer carbonate 2.4 gram powder in packet 90 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0602","type":"HCPCS"},{"code":"65862093190","type":"NDC"}],"standard_charges":[{"gross_charge":7.93,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer carbonate 2.4 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0602","type":"HCPCS"},{"code":"65862093108","type":"NDC"}],"standard_charges":[{"gross_charge":7.93,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sevelamer carbonate 2.4 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0602","type":"HCPCS"},{"code":"58468013101","type":"NDC"}],"standard_charges":[{"gross_charge":70.95,"discounted_cash":17.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288017221","type":"NDC"}],"standard_charges":[{"gross_charge":87.94,"discounted_cash":21.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288014996","type":"NDC"}],"standard_charges":[{"gross_charge":85.64,"discounted_cash":21.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"55150033201","type":"NDC"}],"standard_charges":[{"gross_charge":114.29,"discounted_cash":28.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"72266016201","type":"NDC"}],"standard_charges":[{"gross_charge":96.98,"discounted_cash":24.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"50742040620","type":"NDC"}],"standard_charges":[{"gross_charge":262.74,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethacrynic acid 50 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69315070150","type":"NDC"}],"standard_charges":[{"gross_charge":4738.02,"discounted_cash":1184.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride irrigation 0.9 % solution 1,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"264220100","type":"NDC"}],"standard_charges":[{"gross_charge":37.68,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride irrigation 0.9 % solution 3,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338004747","type":"NDC"}],"standard_charges":[{"gross_charge":56.52,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride irrigation 0.9 % solution 500 mL Bottle","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338004803","type":"NDC"}],"standard_charges":[{"gross_charge":56.52,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water solution 3,000 mL Flex Cont","drug_information":{"unit":0.16667,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"990797308","type":"NDC"}],"standard_charges":[{"gross_charge":23.55,"discounted_cash":5.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water solution 3,000 mL Bag","drug_information":{"unit":0.16667,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"264738660","type":"NDC"}],"standard_charges":[{"gross_charge":23.55,"discounted_cash":5.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water solution 1,500 mL Flex Cont","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338000405","type":"NDC"}],"standard_charges":[{"gross_charge":75.36,"discounted_cash":18.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water solution 1,000 mL Bottle","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338000404","type":"NDC"}],"standard_charges":[{"gross_charge":23.55,"discounted_cash":5.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water solution 500 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338000403","type":"NDC"}],"standard_charges":[{"gross_charge":51.81,"discounted_cash":12.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water solution 3,000 mL Flex Cont","drug_information":{"unit":0.16667,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338000347","type":"NDC"}],"standard_charges":[{"gross_charge":9.42,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water solution 500 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"264210110","type":"NDC"}],"standard_charges":[{"gross_charge":42.39,"discounted_cash":10.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxaliplatin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"43066001801","type":"NDC"}],"standard_charges":[{"gross_charge":156.72,"discounted_cash":39.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sterile water solution 1,000 mL Bottle","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"264210100","type":"NDC"}],"standard_charges":[{"gross_charge":23.55,"discounted_cash":5.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated Ringer's solution 3,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"264738960","type":"NDC"}],"standard_charges":[{"gross_charge":84.78,"discounted_cash":21.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated Ringer's solution 3,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338013727","type":"NDC"}],"standard_charges":[{"gross_charge":56.52,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Ringer's solution 1,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338010404","type":"NDC"}],"standard_charges":[{"gross_charge":28.26,"discounted_cash":7.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pentalyte 800-40-20-8.75- 6.25 mg/100 mL irrigation solution 1,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338019004","type":"NDC"}],"standard_charges":[{"gross_charge":37.68,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride irrigation 0.9 % solution 3,000 mL Flex Cont","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"990797208","type":"NDC"}],"standard_charges":[{"gross_charge":47.1,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride irrigation 0.9 % solution 3,000 mL Bag","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"264738860","type":"NDC"}],"standard_charges":[{"gross_charge":47.1,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride irrigation 0.9 % solution 1,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338004804","type":"NDC"}],"standard_charges":[{"gross_charge":56.52,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sorbitoL 3 % solution 3,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"272","type":"RC"},{"code":"338029547","type":"NDC"}],"standard_charges":[{"gross_charge":84.78,"discounted_cash":21.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lanreotide 120 mg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1932","type":"HCPCS"},{"code":"69097087067","type":"NDC"}],"standard_charges":[{"gross_charge":45676.2,"discounted_cash":11419.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.45 % with KCl 40 mEq/L 40 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"264763800","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.45 % with KCl 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"65219014410","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipenem-cilastatin per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323034994","type":"NDC"}],"standard_charges":[{"gross_charge":42.16,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipenem-cilastatin per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323034925","type":"NDC"}],"standard_charges":[{"gross_charge":44.41,"discounted_cash":11.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorothiazide per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"25021030520","type":"NDC"}],"standard_charges":[{"gross_charge":253.78,"discounted_cash":63.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorothiazide per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"517182001","type":"NDC"}],"standard_charges":[{"gross_charge":314.67,"discounted_cash":78.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorothiazide per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"63323065894","type":"NDC"}],"standard_charges":[{"gross_charge":302.95,"discounted_cash":75.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorothiazide per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"17478041940","type":"NDC"}],"standard_charges":[{"gross_charge":275.45,"discounted_cash":68.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorothiazide per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"47335033040","type":"NDC"}],"standard_charges":[{"gross_charge":256.3,"discounted_cash":64.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorothiazide per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"63323065820","type":"NDC"}],"standard_charges":[{"gross_charge":192.88,"discounted_cash":48.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"338500241","type":"NDC"}],"standard_charges":[{"gross_charge":84.64,"discounted_cash":21.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"264315311","type":"NDC"}],"standard_charges":[{"gross_charge":132.37,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"409733811","type":"NDC"}],"standard_charges":[{"gross_charge":6.67,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505615204","type":"NDC"}],"standard_charges":[{"gross_charge":4.29,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505615201","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipenem-cilastatin per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"6351659","type":"NDC"}],"standard_charges":[{"gross_charge":236.72,"discounted_cash":59.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021010566","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipenem-cilastatin per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323032225","type":"NDC"}],"standard_charges":[{"gross_charge":250.11,"discounted_cash":62.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cladribine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"63323014010","type":"NDC"}],"standard_charges":[{"gross_charge":783.01,"discounted_cash":195.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338381450","type":"NDC"}],"standard_charges":[{"gross_charge":263.12,"discounted_cash":65.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338381424","type":"NDC"}],"standard_charges":[{"gross_charge":263.12,"discounted_cash":65.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9989001","type":"NDC"}],"standard_charges":[{"gross_charge":55.54,"discounted_cash":13.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"781329091","type":"NDC"}],"standard_charges":[{"gross_charge":32.56,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"781329009","type":"NDC"}],"standard_charges":[{"gross_charge":32.56,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9338201","type":"NDC"}],"standard_charges":[{"gross_charge":55.54,"discounted_cash":13.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin in dextrose 5% in water 12 mg/mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338361650","type":"NDC"}],"standard_charges":[{"gross_charge":31.79,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin in dextrose 5% in water 12 mg/mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338361250","type":"NDC"}],"standard_charges":[{"gross_charge":209.12,"discounted_cash":52.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9678001","type":"NDC"}],"standard_charges":[{"gross_charge":45.58,"discounted_cash":11.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9337501","type":"NDC"}],"standard_charges":[{"gross_charge":45.58,"discounted_cash":11.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin in dextrose 5% in water 12 mg/mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"781328991","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin in dextrose 5% in water 12 mg/mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"781328909","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9337502","type":"NDC"}],"standard_charges":[{"gross_charge":45.58,"discounted_cash":11.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cladribine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"42658001001","type":"NDC"}],"standard_charges":[{"gross_charge":1600.79,"discounted_cash":400.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cladribine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"67457045010","type":"NDC"}],"standard_charges":[{"gross_charge":1013.34,"discounted_cash":253.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"imipenem-cilastatin per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0743","type":"HCPCS"},{"code":"63323032294","type":"NDC"}],"standard_charges":[{"gross_charge":76.13,"discounted_cash":19.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"781320785","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"143985825","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"409733801","type":"NDC"}],"standard_charges":[{"gross_charge":6.67,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021010610","type":"NDC"}],"standard_charges":[{"gross_charge":14.06,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"781320885","type":"NDC"}],"standard_charges":[{"gross_charge":12.79,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"64679098301","type":"NDC"}],"standard_charges":[{"gross_charge":50.94,"discounted_cash":12.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505075204","type":"NDC"}],"standard_charges":[{"gross_charge":30.83,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"409733201","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"409508413","type":"NDC"}],"standard_charges":[{"gross_charge":30.37,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021012867","type":"NDC"}],"standard_charges":[{"gross_charge":42.71,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"44567023610","type":"NDC"}],"standard_charges":[{"gross_charge":69.32,"discounted_cash":17.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"gross_charge":41.72,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"781317891","type":"NDC"}],"standard_charges":[{"gross_charge":42.64,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"409508411","type":"NDC"}],"standard_charges":[{"gross_charge":30.37,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021012766","type":"NDC"}],"standard_charges":[{"gross_charge":32.92,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"gross_charge":32.06,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"gross_charge":21.27,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"781317780","type":"NDC"}],"standard_charges":[{"gross_charge":26.7,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"143985701","type":"NDC"}],"standard_charges":[{"gross_charge":17.31,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021010667","type":"NDC"}],"standard_charges":[{"gross_charge":13.93,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505614800","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505614804","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"409733711","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"781320685","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"68180061110","type":"NDC"}],"standard_charges":[{"gross_charge":13.54,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"781320695","type":"NDC"}],"standard_charges":[{"gross_charge":9.51,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"409733701","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505614904","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505614900","type":"NDC"}],"standard_charges":[{"gross_charge":10.38,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338411450","type":"NDC"}],"standard_charges":[{"gross_charge":39.07,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"64679070302","type":"NDC"}],"standard_charges":[{"gross_charge":80.05,"discounted_cash":20.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"143985601","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070225","type":"NDC"}],"standard_charges":[{"gross_charge":51.77,"discounted_cash":12.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021010720","type":"NDC"}],"standard_charges":[{"gross_charge":28.58,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"781320990","type":"NDC"}],"standard_charges":[{"gross_charge":17.34,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"64679070301","type":"NDC"}],"standard_charges":[{"gross_charge":80.05,"discounted_cash":20.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"409733503","type":"NDC"}],"standard_charges":[{"gross_charge":20.01,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"409733211","type":"NDC"}],"standard_charges":[{"gross_charge":10.59,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTRIAXone per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021010768","type":"NDC"}],"standard_charges":[{"gross_charge":15.68,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.45 % with KCl 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"97710503705","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338411424","type":"NDC"}],"standard_charges":[{"gross_charge":39.07,"discounted_cash":9.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, cosyntropin, 0.25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"67457022700","type":"NDC"}],"standard_charges":[{"gross_charge":810.45,"discounted_cash":202.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918089901","type":"NDC"}],"standard_charges":[{"gross_charge":308.11,"discounted_cash":77.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918090110","type":"NDC"}],"standard_charges":[{"gross_charge":4559.31,"discounted_cash":1139.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"55566230000","type":"NDC"}],"standard_charges":[{"gross_charge":3636.2,"discounted_cash":909.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"55566220000","type":"NDC"}],"standard_charges":[{"gross_charge":295.68,"discounted_cash":73.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"55566503000","type":"NDC"}],"standard_charges":[{"gross_charge":180.53,"discounted_cash":45.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"703505103","type":"NDC"}],"standard_charges":[{"gross_charge":556.22,"discounted_cash":139.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"703505101","type":"NDC"}],"standard_charges":[{"gross_charge":556.22,"discounted_cash":139.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"62756052940","type":"NDC"}],"standard_charges":[{"gross_charge":1562.87,"discounted_cash":390.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323020301","type":"NDC"}],"standard_charges":[{"gross_charge":74.23,"discounted_cash":18.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3374","type":"HCPCS"},{"code":"67457070575","type":"NDC"}],"standard_charges":[{"gross_charge":33.56,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"67457070500","type":"NDC"}],"standard_charges":[{"gross_charge":33.56,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323020320","type":"NDC"}],"standard_charges":[{"gross_charge":74.23,"discounted_cash":18.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"409653102","type":"NDC"}],"standard_charges":[{"gross_charge":70.07,"discounted_cash":17.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"67457088005","type":"NDC"}],"standard_charges":[{"gross_charge":18.49,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"67457088000","type":"NDC"}],"standard_charges":[{"gross_charge":18.49,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"43598093109","type":"NDC"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":20.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"64679072808","type":"NDC"}],"standard_charges":[{"gross_charge":28.51,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"43598093111","type":"NDC"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":20.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"43598005311","type":"NDC"}],"standard_charges":[{"gross_charge":1303.04,"discounted_cash":325.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.45 % with KCl 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"65219014404","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.45 % with KCl 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338067104","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.9 % with KCl 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"786292000","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.9 % with KCl 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"97710504005","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.9 % with KCl 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338080304","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % and sodium chloride 0.9 % with KCl 20 mEq/L 20 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"264765200","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5% water with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"97710504105","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5% water with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338068304","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5% water with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"264762500","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"75245153","type":"NDC"}],"standard_charges":[{"gross_charge":2985.18,"discounted_cash":746.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"83634045141","type":"NDC"}],"standard_charges":[{"gross_charge":121.34,"discounted_cash":30.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"83634045110","type":"NDC"}],"standard_charges":[{"gross_charge":1213.42,"discounted_cash":303.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"83634045101","type":"NDC"}],"standard_charges":[{"gross_charge":121.34,"discounted_cash":30.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"39822625001","type":"NDC"}],"standard_charges":[{"gross_charge":1051.26,"discounted_cash":262.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"65219029510","type":"NDC"}],"standard_charges":[{"gross_charge":675.61,"discounted_cash":168.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"desmopressin per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"70860045410","type":"NDC"}],"standard_charges":[{"gross_charge":1084.04,"discounted_cash":271.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"143963801","type":"NDC"}],"standard_charges":[{"gross_charge":85.49,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"55150017301","type":"NDC"}],"standard_charges":[{"gross_charge":27.84,"discounted_cash":6.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"25021070360","type":"NDC"}],"standard_charges":[{"gross_charge":229.03,"discounted_cash":57.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 10 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478093710","type":"NDC"}],"standard_charges":[{"gross_charge":7.26,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 5 mL Vial","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478093705","type":"NDC"}],"standard_charges":[{"gross_charge":15.99,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 5 mL Vial","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409117101","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 10 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409117102","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7516","type":"HCPCS"},{"code":"574086601","type":"NDC"}],"standard_charges":[{"gross_charge":212.87,"discounted_cash":53.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7516","type":"HCPCS"},{"code":"78010961","type":"NDC"}],"standard_charges":[{"gross_charge":505.9,"discounted_cash":126.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7516","type":"HCPCS"},{"code":"574086610","type":"NDC"}],"standard_charges":[{"gross_charge":212.87,"discounted_cash":53.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"degarelix per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9155","type":"HCPCS"},{"code":"55566840301","type":"NDC"}],"standard_charges":[{"gross_charge":3591.47,"discounted_cash":897.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"degarelix per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9155","type":"HCPCS"},{"code":"55566830301","type":"NDC"}],"standard_charges":[{"gross_charge":2301.83,"discounted_cash":575.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cytarabine PF per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703030538","type":"NDC"}],"standard_charges":[{"gross_charge":28.11,"discounted_cash":7.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cytarabine PF per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703030558","type":"NDC"}],"standard_charges":[{"gross_charge":28.11,"discounted_cash":7.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cytarabine PF per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"67457045552","type":"NDC"}],"standard_charges":[{"gross_charge":29.22,"discounted_cash":7.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cytarabine PF per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"67457045500","type":"NDC"}],"standard_charges":[{"gross_charge":29.22,"discounted_cash":7.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, cosyntropin, 0.25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"781344095","type":"NDC"}],"standard_charges":[{"gross_charge":235.63,"discounted_cash":58.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, cosyntropin, 0.25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"781344071","type":"NDC"}],"standard_charges":[{"gross_charge":235.63,"discounted_cash":58.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 25 mL Vial","drug_information":{"unit":0.16,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478093725","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 5 mL Vial","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"641601301","type":"NDC"}],"standard_charges":[{"gross_charge":17.86,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 10 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"641601401","type":"NDC"}],"standard_charges":[{"gross_charge":16.27,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 25 mL Vial","drug_information":{"unit":0.16,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"641601501","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"64679072801","type":"NDC"}],"standard_charges":[{"gross_charge":28.51,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"63323027301","type":"NDC"}],"standard_charges":[{"gross_charge":43.51,"discounted_cash":10.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"781317471","type":"NDC"}],"standard_charges":[{"gross_charge":600.18,"discounted_cash":150.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMAtriptan per 6 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"781317414","type":"NDC"}],"standard_charges":[{"gross_charge":600.18,"discounted_cash":150.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 25 mL Vial","drug_information":{"unit":0.16,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021031925","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 10 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021031910","type":"NDC"}],"standard_charges":[{"gross_charge":7.66,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 5 mL Vial","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021031905","type":"NDC"}],"standard_charges":[{"gross_charge":12.53,"discounted_cash":3.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, cosyntropin, 0.25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0834","type":"HCPCS"},{"code":"548590000","type":"NDC"}],"standard_charges":[{"gross_charge":160.38,"discounted_cash":40.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 5 mL Vial","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150042510","type":"NDC"}],"standard_charges":[{"gross_charge":23.53,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 25 mL Vial","drug_information":{"unit":0.16,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860030125","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 5 mL Vial","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860030105","type":"NDC"}],"standard_charges":[{"gross_charge":18.54,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 5 mL Vial","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860030141","type":"NDC"}],"standard_charges":[{"gross_charge":18.54,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 10 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409117112","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 25 mL Vial","drug_information":{"unit":0.16,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478081725","type":"NDC"}],"standard_charges":[{"gross_charge":15.38,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 10 mL Vial","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478081710","type":"NDC"}],"standard_charges":[{"gross_charge":10.26,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 5 mL Vial","drug_information":{"unit":0.8,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478081705","type":"NDC"}],"standard_charges":[{"gross_charge":19.79,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem 5 mg/mL solution 25 mL Vial","drug_information":{"unit":0.16,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860030143","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lanreotide 120 mg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"},{"code":"15054112004","type":"NDC"}],"standard_charges":[{"gross_charge":73061.85,"discounted_cash":18265.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lanreotide 90 mg/0.3 mL syringe 0.3 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"},{"code":"15054109004","type":"NDC"}],"standard_charges":[{"gross_charge":61952.01,"discounted_cash":15488.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinCRIStine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030906","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 2.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"904714110","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 2.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"16729048601","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 2.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"51079067001","type":"NDC"}],"standard_charges":[{"gross_charge":12.31,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mannitol per 50 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323002425","type":"NDC"}],"standard_charges":[{"gross_charge":61.28,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mannitol per 50 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409403116","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mannitol per 50 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409403101","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mannitol per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"990771512","type":"NDC"}],"standard_charges":[{"gross_charge":82.35,"discounted_cash":20.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mannitol per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"990771502","type":"NDC"}],"standard_charges":[{"gross_charge":82.35,"discounted_cash":20.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mannitol per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"990771513","type":"NDC"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":22.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mannitol per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338035703","type":"NDC"}],"standard_charges":[{"gross_charge":241.29,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mannitol per 12.5 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"264757810","type":"NDC"}],"standard_charges":[{"gross_charge":363.85,"discounted_cash":90.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"65219001601","type":"NDC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67850002410","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67850002400","type":"NDC"}],"standard_charges":[{"gross_charge":10.77,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781925095","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 2.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"54855025","type":"NDC"}],"standard_charges":[{"gross_charge":15.97,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781925078","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylene blue per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"17478050410","type":"NDC"}],"standard_charges":[{"gross_charge":1384.7,"discounted_cash":346.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone 4 mg tablets,dose pack 21 each DOSE-PACK","drug_information":{"unit":0.04762,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"9005604","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 80 mg","drug_information":{"unit":0.1014,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"781351675","type":"NDC"}],"standard_charges":[{"gross_charge":22.94,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 80 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157405","type":"NDC"}],"standard_charges":[{"gross_charge":30.67,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 80 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157401","type":"NDC"}],"standard_charges":[{"gross_charge":30.68,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 80 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"9347501","type":"NDC"}],"standard_charges":[{"gross_charge":21.1,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 80 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"9030602","type":"NDC"}],"standard_charges":[{"gross_charge":33.25,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 80 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"703005101","type":"NDC"}],"standard_charges":[{"gross_charge":75.53,"discounted_cash":18.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 40 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 40 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157301","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 40 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"9307301","type":"NDC"}],"standard_charges":[{"gross_charge":6.89,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone acetate per 40 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"703003101","type":"NDC"}],"standard_charges":[{"gross_charge":21.54,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone 4 mg tablets,dose pack 21 each DOSE-PACK","drug_information":{"unit":0.04762,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"59746000103","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone 4 mg tablets,dose pack 21 each DOSE-PACK","drug_information":{"unit":0.04762,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"42806040021","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone 4 mg tablets,dose pack 21 each DOSE-PACK","drug_information":{"unit":0.04762,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"781502207","type":"NDC"}],"standard_charges":[{"gross_charge":5.56,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone 4 mg tablets,dose pack 21 each DOSE-PACK","drug_information":{"unit":0.04762,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"603459315","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone 4 mg tablets,dose pack 21 each DOSE-PACK","drug_information":{"unit":0.04762,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7509","type":"HCPCS"},{"code":"59762444002","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylene blue per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"17478050401","type":"NDC"}],"standard_charges":[{"gross_charge":138.47,"discounted_cash":34.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781340778","type":"NDC"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"25021013510","type":"NDC"}],"standard_charges":[{"gross_charge":10.69,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"44567010110","type":"NDC"}],"standard_charges":[{"gross_charge":27.57,"discounted_cash":6.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"72485042210","type":"NDC"}],"standard_charges":[{"gross_charge":18.53,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"72485042201","type":"NDC"}],"standard_charges":[{"gross_charge":18.53,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67457035202","type":"NDC"}],"standard_charges":[{"gross_charge":57.73,"discounted_cash":14.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67457035210","type":"NDC"}],"standard_charges":[{"gross_charge":57.73,"discounted_cash":14.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781927380","type":"NDC"}],"standard_charges":[{"gross_charge":83.85,"discounted_cash":20.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781340880","type":"NDC"}],"standard_charges":[{"gross_charge":83.85,"discounted_cash":20.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"25021013720","type":"NDC"}],"standard_charges":[{"gross_charge":25.38,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"44567010310","type":"NDC"}],"standard_charges":[{"gross_charge":24.06,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781340895","type":"NDC"}],"standard_charges":[{"gross_charge":27.08,"discounted_cash":6.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"72485042110","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"72485042101","type":"NDC"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67457035110","type":"NDC"}],"standard_charges":[{"gross_charge":39.39,"discounted_cash":9.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"67457035101","type":"NDC"}],"standard_charges":[{"gross_charge":39.39,"discounted_cash":9.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781926185","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409216802","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006426","type":"NDC"}],"standard_charges":[{"gross_charge":7.74,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323064220","type":"NDC"}],"standard_charges":[{"gross_charge":33.55,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323064250","type":"NDC"}],"standard_charges":[{"gross_charge":98.05,"discounted_cash":24.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781340795","type":"NDC"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"264420552","type":"NDC"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"338171940","type":"NDC"}],"standard_charges":[{"gross_charge":13.79,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010701","type":"NDC"}],"standard_charges":[{"gross_charge":62.05,"discounted_cash":15.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010705","type":"NDC"}],"standard_charges":[{"gross_charge":62.05,"discounted_cash":15.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409673013","type":"NDC"}],"standard_charges":[{"gross_charge":34.47,"discounted_cash":8.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006402","type":"NDC"}],"standard_charges":[{"gross_charge":13.93,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"409341401","type":"NDC"}],"standard_charges":[{"gross_charge":7.57,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409216877","type":"NDC"}],"standard_charges":[{"gross_charge":28.04,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006443","type":"NDC"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006441","type":"NDC"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"51754100004","type":"NDC"}],"standard_charges":[{"gross_charge":21.68,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"51754100001","type":"NDC"}],"standard_charges":[{"gross_charge":21.68,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006411","type":"NDC"}],"standard_charges":[{"gross_charge":20.45,"discounted_cash":5.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006404","type":"NDC"}],"standard_charges":[{"gross_charge":20.45,"discounted_cash":5.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006401","type":"NDC"}],"standard_charges":[{"gross_charge":8.33,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409216817","type":"NDC"}],"standard_charges":[{"gross_charge":28.04,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"gross_charge":9.79,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"703450201","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"23155024031","type":"NDC"}],"standard_charges":[{"gross_charge":42.62,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"641620501","type":"NDC"}],"standard_charges":[{"gross_charge":128.86,"discounted_cash":32.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"67457099202","type":"NDC"}],"standard_charges":[{"gross_charge":61.66,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"55150034510","type":"NDC"}],"standard_charges":[{"gross_charge":97.37,"discounted_cash":24.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"55150034501","type":"NDC"}],"standard_charges":[{"gross_charge":97.37,"discounted_cash":24.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"76329346901","type":"NDC"}],"standard_charges":[{"gross_charge":99.96,"discounted_cash":24.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"76329146901","type":"NDC"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":108.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"gross_charge":292.31,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"409121521","type":"NDC"}],"standard_charges":[{"gross_charge":21.03,"discounted_cash":5.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"70069007110","type":"NDC"}],"standard_charges":[{"gross_charge":29.36,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"70069007101","type":"NDC"}],"standard_charges":[{"gross_charge":29.36,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"641613225","type":"NDC"}],"standard_charges":[{"gross_charge":26.76,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"641613201","type":"NDC"}],"standard_charges":[{"gross_charge":26.76,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"67457059902","type":"NDC"}],"standard_charges":[{"gross_charge":23.16,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"67457059900","type":"NDC"}],"standard_charges":[{"gross_charge":93.67,"discounted_cash":23.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"gross_charge":33.05,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"641620510","type":"NDC"}],"standard_charges":[{"gross_charge":128.86,"discounted_cash":32.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"67457029200","type":"NDC"}],"standard_charges":[{"gross_charge":33.05,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, nitroglycerin, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517481025","type":"NDC"}],"standard_charges":[{"gross_charge":90.62,"discounted_cash":22.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"25021014610","type":"NDC"}],"standard_charges":[{"gross_charge":128.98,"discounted_cash":32.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"63323081220","type":"NDC"}],"standard_charges":[{"gross_charge":44.37,"discounted_cash":11.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"63323081201","type":"NDC"}],"standard_charges":[{"gross_charge":44.37,"discounted_cash":11.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"70655010995","type":"NDC"}],"standard_charges":[{"gross_charge":67.54,"discounted_cash":16.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"70655010980","type":"NDC"}],"standard_charges":[{"gross_charge":67.54,"discounted_cash":16.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"64679069902","type":"NDC"}],"standard_charges":[{"gross_charge":67.42,"discounted_cash":16.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"64679069901","type":"NDC"}],"standard_charges":[{"gross_charge":67.42,"discounted_cash":16.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"55150012824","type":"NDC"}],"standard_charges":[{"gross_charge":64.39,"discounted_cash":16.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"25021016224","type":"NDC"}],"standard_charges":[{"gross_charge":204.51,"discounted_cash":51.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 10 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"55150012999","type":"NDC"}],"standard_charges":[{"gross_charge":372.89,"discounted_cash":93.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"63323081320","type":"NDC"}],"standard_charges":[{"gross_charge":22.83,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"63323081301","type":"NDC"}],"standard_charges":[{"gross_charge":22.83,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"70655009985","type":"NDC"}],"standard_charges":[{"gross_charge":99.11,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"64679069802","type":"NDC"}],"standard_charges":[{"gross_charge":36.97,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"64679069801","type":"NDC"}],"standard_charges":[{"gross_charge":36.97,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 1 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"55150012715","type":"NDC"}],"standard_charges":[{"gross_charge":49.98,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, nitroglycerin, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517481001","type":"NDC"}],"standard_charges":[{"gross_charge":90.62,"discounted_cash":22.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naloxone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2312","type":"HCPCS"},{"code":"409121501","type":"NDC"}],"standard_charges":[{"gross_charge":21.03,"discounted_cash":5.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nalbuphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"409146761","type":"NDC"}],"standard_charges":[{"gross_charge":378.4,"discounted_cash":94.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nalbuphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"409146571","type":"NDC"}],"standard_charges":[{"gross_charge":49.81,"discounted_cash":12.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"70860030005","type":"NDC"}],"standard_charges":[{"gross_charge":13.94,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"143987325","type":"NDC"}],"standard_charges":[{"gross_charge":20.84,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"143966001","type":"NDC"}],"standard_charges":[{"gross_charge":25.16,"discounted_cash":6.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"36000003310","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"143966010","type":"NDC"}],"standard_charges":[{"gross_charge":25.16,"discounted_cash":6.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"63323066005","type":"NDC"}],"standard_charges":[{"gross_charge":20.64,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"25021030305","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"409177805","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"143987310","type":"NDC"}],"standard_charges":[{"gross_charge":3.41,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"83634077941","type":"NDC"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"83634077902","type":"NDC"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"409341421","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"409341411","type":"NDC"}],"standard_charges":[{"gross_charge":7.69,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"409341418","type":"NDC"}],"standard_charges":[{"gross_charge":7.57,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"23155024041","type":"NDC"}],"standard_charges":[{"gross_charge":42.62,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"47781058717","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"47781058720","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"409177815","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoprolol 5 mg/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0616","type":"HCPCS"},{"code":"70860030041","type":"NDC"}],"standard_charges":[{"gross_charge":13.94,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nalbuphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"409146501","type":"NDC"}],"standard_charges":[{"gross_charge":49.81,"discounted_cash":12.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nalbuphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"409146461","type":"NDC"}],"standard_charges":[{"gross_charge":254.7,"discounted_cash":63.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nalbuphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"409146371","type":"NDC"}],"standard_charges":[{"gross_charge":28.93,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nalbuphine per 10 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"97710500501","type":"NDC"}],"standard_charges":[{"gross_charge":23.85,"discounted_cash":5.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nalbuphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"409146401","type":"NDC"}],"standard_charges":[{"gross_charge":254.7,"discounted_cash":63.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nalbuphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"409146301","type":"NDC"}],"standard_charges":[{"gross_charge":28.93,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":0.067,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"641607201","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide per 10 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"703450204","type":"NDC"}],"standard_charges":[{"gross_charge":7.94,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"641607101","type":"NDC"}],"standard_charges":[{"gross_charge":7.31,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, metronidazole, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, metronidazole, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021013182","type":"NDC"}],"standard_charges":[{"gross_charge":14.55,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, metronidazole, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338955450","type":"NDC"}],"standard_charges":[{"gross_charge":6.89,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, metronidazole, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338954124","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, metronidazole, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338105548","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, metronidazole, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"264553532","type":"NDC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, metronidazole, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409781124","type":"NDC"}],"standard_charges":[{"gross_charge":9.19,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, metronidazole, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409015201","type":"NDC"}],"standard_charges":[{"gross_charge":9.19,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"72485040901","type":"NDC"}],"standard_charges":[{"gross_charge":73.11,"discounted_cash":18.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"25021013610","type":"NDC"}],"standard_charges":[{"gross_charge":17.07,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781340485","type":"NDC"}],"standard_charges":[{"gross_charge":13.93,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"97710510401","type":"NDC"}],"standard_charges":[{"gross_charge":3.38,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189303","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"641612701","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189301","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037805","type":"NDC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide per 25 mcg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"703333301","type":"NDC"}],"standard_charges":[{"gross_charge":41.74,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045100","type":"NDC"}],"standard_charges":[{"gross_charge":14.29,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045101","type":"NDC"}],"standard_charges":[{"gross_charge":7.14,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189323","type":"NDC"}],"standard_charges":[{"gross_charge":32.92,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate PF per 5 mg","drug_information":{"unit":0.4,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"5446150505","type":"NDC"}],"standard_charges":[{"gross_charge":796.64,"discounted_cash":199.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"641619210","type":"NDC"}],"standard_charges":[{"gross_charge":52.72,"discounted_cash":13.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"641619201","type":"NDC"}],"standard_charges":[{"gross_charge":52.72,"discounted_cash":13.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189123","type":"NDC"}],"standard_charges":[{"gross_charge":64.88,"discounted_cash":16.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189113","type":"NDC"}],"standard_charges":[{"gross_charge":64.88,"discounted_cash":16.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"gross_charge":41.15,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000501","type":"NDC"}],"standard_charges":[{"gross_charge":41.15,"discounted_cash":10.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045401","type":"NDC"}],"standard_charges":[{"gross_charge":32.44,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045400","type":"NDC"}],"standard_charges":[{"gross_charge":32.44,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"97710510501","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189103","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"641612525","type":"NDC"}],"standard_charges":[{"gross_charge":8.15,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"641612501","type":"NDC"}],"standard_charges":[{"gross_charge":40.73,"discounted_cash":10.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":2.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000510","type":"NDC"}],"standard_charges":[{"gross_charge":26.73,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189101","type":"NDC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189313","type":"NDC"}],"standard_charges":[{"gross_charge":32.92,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"97710522901","type":"NDC"}],"standard_charges":[{"gross_charge":96.29,"discounted_cash":24.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"76329191201","type":"NDC"}],"standard_charges":[{"gross_charge":72.62,"discounted_cash":18.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71266200108","type":"NDC"}],"standard_charges":[{"gross_charge":111.84,"discounted_cash":27.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71288071911","type":"NDC"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71288071910","type":"NDC"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71266200102","type":"NDC"}],"standard_charges":[{"gross_charge":106.55,"discounted_cash":26.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"54879003750","type":"NDC"}],"standard_charges":[{"gross_charge":24.97,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"31722098131","type":"NDC"}],"standard_charges":[{"gross_charge":30.49,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"31722098110","type":"NDC"}],"standard_charges":[{"gross_charge":30.49,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"54879003725","type":"NDC"}],"standard_charges":[{"gross_charge":25.43,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"succinylcholine per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"54879003710","type":"NDC"}],"standard_charges":[{"gross_charge":24.97,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189001","type":"NDC"}],"standard_charges":[{"gross_charge":58.71,"discounted_cash":14.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189003","type":"NDC"}],"standard_charges":[{"gross_charge":58.71,"discounted_cash":14.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"97710510601","type":"NDC"}],"standard_charges":[{"gross_charge":51.21,"discounted_cash":12.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045200","type":"NDC"}],"standard_charges":[{"gross_charge":62.08,"discounted_cash":15.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323028420","type":"NDC"}],"standard_charges":[{"gross_charge":121.8,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323028401","type":"NDC"}],"standard_charges":[{"gross_charge":121.8,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"gross_charge":18.81,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"72611076501","type":"NDC"}],"standard_charges":[{"gross_charge":18.81,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323028441","type":"NDC"}],"standard_charges":[{"gross_charge":19.95,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"51991094199","type":"NDC"}],"standard_charges":[{"gross_charge":30.89,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"51991094117","type":"NDC"}],"standard_charges":[{"gross_charge":30.89,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"esomeprazole 40 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457039299","type":"NDC"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"70860010520","type":"NDC"}],"standard_charges":[{"gross_charge":57.46,"discounted_cash":14.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"67457034000","type":"NDC"}],"standard_charges":[{"gross_charge":14.07,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"641619110","type":"NDC"}],"standard_charges":[{"gross_charge":198.66,"discounted_cash":49.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189023","type":"NDC"}],"standard_charges":[{"gross_charge":115.24,"discounted_cash":28.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"409189013","type":"NDC"}],"standard_charges":[{"gross_charge":115.24,"discounted_cash":28.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000411","type":"NDC"}],"standard_charges":[{"gross_charge":80.47,"discounted_cash":20.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000401","type":"NDC"}],"standard_charges":[{"gross_charge":80.47,"discounted_cash":20.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine per 10 mg","drug_information":{"unit":5.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045201","type":"NDC"}],"standard_charges":[{"gross_charge":62.08,"discounted_cash":15.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323028426","type":"NDC"}],"standard_charges":[{"gross_charge":23.42,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"44567010210","type":"NDC"}],"standard_charges":[{"gross_charge":21.38,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphth,pertus(acell),tetanus per 0.5 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"gross_charge":282.64,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fludarabine per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9185","type":"HCPCS"},{"code":"63323019202","type":"NDC"}],"standard_charges":[{"gross_charge":451.17,"discounted_cash":112.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"gross_charge":24.82,"discounted_cash":6.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70756064687","type":"NDC"}],"standard_charges":[{"gross_charge":7.35,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70756064586","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70756064525","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323020103","type":"NDC"}],"standard_charges":[{"gross_charge":24.82,"discounted_cash":6.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048541","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048503","type":"NDC"}],"standard_charges":[{"gross_charge":41.36,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048501","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150025220","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150025110","type":"NDC"}],"standard_charges":[{"gross_charge":6.97,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143957710","type":"NDC"}],"standard_charges":[{"gross_charge":14.17,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143957701","type":"NDC"}],"standard_charges":[{"gross_charge":14.17,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427617","type":"NDC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427616","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048526","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427701","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048557","type":"NDC"}],"standard_charges":[{"gross_charge":41.36,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427702","type":"NDC"}],"standard_charges":[{"gross_charge":30.26,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427717","type":"NDC"}],"standard_charges":[{"gross_charge":30.26,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ampicillin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"781340495","type":"NDC"}],"standard_charges":[{"gross_charge":13.93,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amphotericin B per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0285","type":"HCPCS"},{"code":"39822105505","type":"NDC"}],"standard_charges":[{"gross_charge":275.15,"discounted_cash":68.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine (cardiac) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409490311","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":12.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine (cardiac) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409132315","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine (cardiac) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine (cardiac) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409490334","type":"NDC"}],"standard_charges":[{"gross_charge":49.75,"discounted_cash":12.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine (cardiac) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409132305","type":"NDC"}],"standard_charges":[{"gross_charge":42.86,"discounted_cash":10.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 40 mg/mL (4 %) solution 5 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409428325","type":"NDC"}],"standard_charges":[{"gross_charge":27.04,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 40 mg/mL (4 %) solution 5 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409428311","type":"NDC"}],"standard_charges":[{"gross_charge":27.04,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 40 mg/mL (4 %) solution 5 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409428301","type":"NDC"}],"standard_charges":[{"gross_charge":27.04,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048641","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048602","type":"NDC"}],"standard_charges":[{"gross_charge":27.88,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150025520","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427716","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048626","type":"NDC"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048627","type":"NDC"}],"standard_charges":[{"gross_charge":27.88,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048527","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated Ringer's per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"264775010","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated Ringer's per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"264775000","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cetuximab per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"97710509101","type":"NDC"}],"standard_charges":[{"gross_charge":5334.04,"discounted_cash":1333.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinorelbine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9390","type":"HCPCS"},{"code":"67457047953","type":"NDC"}],"standard_charges":[{"gross_charge":792.81,"discounted_cash":198.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinorelbine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9390","type":"HCPCS"},{"code":"45963060756","type":"NDC"}],"standard_charges":[{"gross_charge":689.4,"discounted_cash":172.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinorelbine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9390","type":"HCPCS"},{"code":"25021020405","type":"NDC"}],"standard_charges":[{"gross_charge":352.36,"discounted_cash":88.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinorelbine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9390","type":"HCPCS"},{"code":"64370053202","type":"NDC"}],"standard_charges":[{"gross_charge":257.84,"discounted_cash":64.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tigecycline per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"70121164707","type":"NDC"}],"standard_charges":[{"gross_charge":123.26,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tigecycline per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"70121164701","type":"NDC"}],"standard_charges":[{"gross_charge":123.26,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tigecycline per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"8499420","type":"NDC"}],"standard_charges":[{"gross_charge":373.49,"discounted_cash":93.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tigecycline per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"8499419","type":"NDC"}],"standard_charges":[{"gross_charge":373.49,"discounted_cash":93.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tigecycline per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"8499019","type":"NDC"}],"standard_charges":[{"gross_charge":507.51,"discounted_cash":126.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tigecycline per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"8499001","type":"NDC"}],"standard_charges":[{"gross_charge":1050.83,"discounted_cash":262.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glucagon (human recombinant) per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"548585000","type":"NDC"}],"standard_charges":[{"gross_charge":1377.57,"discounted_cash":344.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fludarabine per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9185","type":"HCPCS"},{"code":"25021024202","type":"NDC"}],"standard_charges":[{"gross_charge":616.25,"discounted_cash":154.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated ringers amnioinfusion solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"338011702","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated Ringer's per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"990795309","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine 5 mg/mL (0.5 %) solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048457","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":4.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081310","type":"NDC"}],"standard_charges":[{"gross_charge":34.8,"discounted_cash":8.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"70436011980","type":"NDC"}],"standard_charges":[{"gross_charge":109.61,"discounted_cash":27.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016330","type":"NDC"}],"standard_charges":[{"gross_charge":195.79,"discounted_cash":48.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457053035","type":"NDC"}],"standard_charges":[{"gross_charge":1086.11,"discounted_cash":271.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"143955201","type":"NDC"}],"standard_charges":[{"gross_charge":105.1,"discounted_cash":26.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"703514501","type":"NDC"}],"standard_charges":[{"gross_charge":1099.82,"discounted_cash":274.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphth,pertus(acell),tetanus per 0.5 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160084243","type":"NDC"}],"standard_charges":[{"gross_charge":282.64,"discounted_cash":70.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081667","type":"NDC"}],"standard_charges":[{"gross_charge":80.2,"discounted_cash":20.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin calcium per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457052810","type":"NDC"}],"standard_charges":[{"gross_charge":296.21,"discounted_cash":74.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin calcium per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"143955401","type":"NDC"}],"standard_charges":[{"gross_charge":33.63,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin calcium per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021081467","type":"NDC"}],"standard_charges":[{"gross_charge":40.14,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lanthanum 750 MG tablet,chewable 15 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0607","type":"HCPCS"},{"code":"54092025315","type":"NDC"}],"standard_charges":[{"gross_charge":85.58,"discounted_cash":21.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated Ringer's per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"3947000","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated Ringer's per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"786160000","type":"NDC"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":75.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lactated Ringer's per 1000 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"61085000","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081630","type":"NDC"}],"standard_charges":[{"gross_charge":398.78,"discounted_cash":99.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate in sodium chloride 2 gram/100 mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"44567062101","type":"NDC"}],"standard_charges":[{"gross_charge":138.65,"discounted_cash":34.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxacillin 2 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2700","type":"HCPCS"},{"code":"72485040910","type":"NDC"}],"standard_charges":[{"gross_charge":73.11,"discounted_cash":18.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin per 10 Units","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"42023011602","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001326","type":"NDC"}],"standard_charges":[{"gross_charge":19.95,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"67457019600","type":"NDC"}],"standard_charges":[{"gross_charge":12.03,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"55150039301","type":"NDC"}],"standard_charges":[{"gross_charge":224.74,"discounted_cash":56.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598014362","type":"NDC"}],"standard_charges":[{"gross_charge":224.74,"discounted_cash":56.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"69097080540","type":"NDC"}],"standard_charges":[{"gross_charge":338.19,"discounted_cash":84.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"16729030610","type":"NDC"}],"standard_charges":[{"gross_charge":445.66,"discounted_cash":111.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"72485020101","type":"NDC"}],"standard_charges":[{"gross_charge":414.1,"discounted_cash":103.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598067811","type":"NDC"}],"standard_charges":[{"gross_charge":3063.92,"discounted_cash":765.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"51991079798","type":"NDC"}],"standard_charges":[{"gross_charge":372.51,"discounted_cash":93.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"63323077139","type":"NDC"}],"standard_charges":[{"gross_charge":1097.3,"discounted_cash":274.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"64679009602","type":"NDC"}],"standard_charges":[{"gross_charge":513.3,"discounted_cash":128.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"64679009601","type":"NDC"}],"standard_charges":[{"gross_charge":513.3,"discounted_cash":128.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598030562","type":"NDC"}],"standard_charges":[{"gross_charge":144.31,"discounted_cash":36.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"781325394","type":"NDC"}],"standard_charges":[{"gross_charge":1007.37,"discounted_cash":251.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaCITIDine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"59572010201","type":"NDC"}],"standard_charges":[{"gross_charge":4471.75,"discounted_cash":1117.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001301","type":"NDC"}],"standard_charges":[{"gross_charge":18.27,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophil FVIII,full length 2,000 (+/-) unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944304510","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001341","type":"NDC"}],"standard_charges":[{"gross_charge":9.98,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"641622801","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"143938701","type":"NDC"}],"standard_charges":[{"gross_charge":70.17,"discounted_cash":17.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"67457062199","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"67457062102","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"703024101","type":"NDC"}],"standard_charges":[{"gross_charge":26.27,"discounted_cash":6.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121165701","type":"NDC"}],"standard_charges":[{"gross_charge":25.58,"discounted_cash":6.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121104902","type":"NDC"}],"standard_charges":[{"gross_charge":71.7,"discounted_cash":17.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121104905","type":"NDC"}],"standard_charges":[{"gross_charge":25.81,"discounted_cash":6.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121104901","type":"NDC"}],"standard_charges":[{"gross_charge":71.7,"discounted_cash":17.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"3029305","type":"NDC"}],"standard_charges":[{"gross_charge":71.54,"discounted_cash":17.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"gross_charge":18.27,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"31722036332","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"31722036331","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"43598005025","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"43598005011","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"641622825","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiamine per 100 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"25021050002","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"testosterone cypionate per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"69097053731","type":"NDC"}],"standard_charges":[{"gross_charge":97.51,"discounted_cash":24.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"testosterone cypionate per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"409656202","type":"NDC"}],"standard_charges":[{"gross_charge":66.26,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"testosterone cypionate per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"143965901","type":"NDC"}],"standard_charges":[{"gross_charge":130.99,"discounted_cash":32.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"25021078005","type":"NDC"}],"standard_charges":[{"gross_charge":15.86,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"143967310","type":"NDC"}],"standard_charges":[{"gross_charge":23.17,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"39822400001","type":"NDC"}],"standard_charges":[{"gross_charge":17.81,"discounted_cash":4.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rasburicase per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"24515174","type":"NDC"}],"standard_charges":[{"gross_charge":41666.8,"discounted_cash":10416.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rasburicase per 0.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2783","type":"HCPCS"},{"code":"24515175","type":"NDC"}],"standard_charges":[{"gross_charge":41666.8,"discounted_cash":10416.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"naltrexone 380 mg suspension,extended rel recon 1 each KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2315","type":"HCPCS"},{"code":"65757030001","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophil FVIII,full length 1,500 (+/-) unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944305404","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophil FVIII,full length 1,500 (+/-) unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944305403","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophil FVIII,full length 1,500 (+/-) unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944305402","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophil FVIII,full length 1,000 (+/-) unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944305304","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophil FVIII,full length 1,000 (+/-) unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944305303","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophil FVIII,full length 1,000 (+/-) unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944305302","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophil FVIII,full length 500 (+/-) unit recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7192","type":"HCPCS"},{"code":"944305202","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"decitabine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"71288011920","type":"NDC"}],"standard_charges":[{"gross_charge":396.48,"discounted_cash":99.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"decitabine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"55150037601","type":"NDC"}],"standard_charges":[{"gross_charge":403.45,"discounted_cash":100.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323040005","type":"NDC"}],"standard_charges":[{"gross_charge":37.8,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"143967301","type":"NDC"}],"standard_charges":[{"gross_charge":39.6,"discounted_cash":9.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"gross_charge":7.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"409188622","type":"NDC"}],"standard_charges":[{"gross_charge":8.66,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"testosterone cypionate per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"409656201","type":"NDC"}],"standard_charges":[{"gross_charge":72.77,"discounted_cash":18.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"testosterone cypionate per 1 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"143972601","type":"NDC"}],"standard_charges":[{"gross_charge":57.49,"discounted_cash":14.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"testosterone cypionate per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"9041701","type":"NDC"}],"standard_charges":[{"gross_charge":182.31,"discounted_cash":45.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"micafungin 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2248","type":"HCPCS"},{"code":"71288002911","type":"NDC"}],"standard_charges":[{"gross_charge":164.13,"discounted_cash":41.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"micafungin 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2248","type":"HCPCS"},{"code":"71288002910","type":"NDC"}],"standard_charges":[{"gross_charge":164.13,"discounted_cash":41.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323040001","type":"NDC"}],"standard_charges":[{"gross_charge":37.8,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43547045441","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"143938725","type":"NDC"}],"standard_charges":[{"gross_charge":70.17,"discounted_cash":17.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43547045410","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72485010601","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323040044","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323040041","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"409188615","type":"NDC"}],"standard_charges":[{"gross_charge":11.11,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"409188605","type":"NDC"}],"standard_charges":[{"gross_charge":11.11,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457079005","type":"NDC"}],"standard_charges":[{"gross_charge":96.52,"discounted_cash":24.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457079000","type":"NDC"}],"standard_charges":[{"gross_charge":96.52,"discounted_cash":24.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72485010610","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"decitabine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"70860021920","type":"NDC"}],"standard_charges":[{"gross_charge":510.08,"discounted_cash":127.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"78043561","type":"NDC"}],"standard_charges":[{"gross_charge":8503.37,"discounted_cash":2125.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111068852","type":"NDC"}],"standard_charges":[{"gross_charge":489.47,"discounted_cash":122.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"143916210","type":"NDC"}],"standard_charges":[{"gross_charge":18.28,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"143916201","type":"NDC"}],"standard_charges":[{"gross_charge":18.28,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"143935710","type":"NDC"}],"standard_charges":[{"gross_charge":20.09,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"143935701","type":"NDC"}],"standard_charges":[{"gross_charge":20.09,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"409653321","type":"NDC"}],"standard_charges":[{"gross_charge":114.29,"discounted_cash":28.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"gross_charge":18.14,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"409653311","type":"NDC"}],"standard_charges":[{"gross_charge":114.29,"discounted_cash":28.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72611064225","type":"NDC"}],"standard_charges":[{"gross_charge":9.12,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72611064201","type":"NDC"}],"standard_charges":[{"gross_charge":9.12,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9090106","type":"NDC"}],"standard_charges":[{"gross_charge":6.57,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9060204","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9087021","type":"NDC"}],"standard_charges":[{"gross_charge":18.02,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021011506","type":"NDC"}],"standard_charges":[{"gross_charge":6.07,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"71288002320","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021011504","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"67457033950","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinCRIStine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"703440211","type":"NDC"}],"standard_charges":[{"gross_charge":105.25,"discounted_cash":26.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinBLAStine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9360","type":"HCPCS"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"gross_charge":385.83,"discounted_cash":96.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323029561","type":"NDC"}],"standard_charges":[{"gross_charge":609.05,"discounted_cash":152.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"70436002282","type":"NDC"}],"standard_charges":[{"gross_charge":98.12,"discounted_cash":24.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323029566","type":"NDC"}],"standard_charges":[{"gross_charge":171.51,"discounted_cash":42.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"67457034105","type":"NDC"}],"standard_charges":[{"gross_charge":97.36,"discounted_cash":24.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"25021015799","type":"NDC"}],"standard_charges":[{"gross_charge":143.17,"discounted_cash":35.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"409650901","type":"NDC"}],"standard_charges":[{"gross_charge":642.98,"discounted_cash":160.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323022110","type":"NDC"}],"standard_charges":[{"gross_charge":53.62,"discounted_cash":13.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"71288002211","type":"NDC"}],"standard_charges":[{"gross_charge":14.42,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"71288002210","type":"NDC"}],"standard_charges":[{"gross_charge":14.42,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"70594012202","type":"NDC"}],"standard_charges":[{"gross_charge":13.14,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3375","type":"HCPCS"},{"code":"70594012201","type":"NDC"}],"standard_charges":[{"gross_charge":13.14,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"63323022101","type":"NDC"}],"standard_charges":[{"gross_charge":53.62,"discounted_cash":13.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3374","type":"HCPCS"},{"code":"67457033900","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":0.33333,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9090211","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"9077526","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temsirolimus per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9330","type":"HCPCS"},{"code":"72611078001","type":"NDC"}],"standard_charges":[{"gross_charge":2872.5,"discounted_cash":718.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011758","type":"NDC"}],"standard_charges":[{"gross_charge":55.92,"discounted_cash":13.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"16729027611","type":"NDC"}],"standard_charges":[{"gross_charge":227.5,"discounted_cash":56.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150019410","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"67457018200","type":"NDC"}],"standard_charges":[{"gross_charge":45.65,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"10019012039","type":"NDC"}],"standard_charges":[{"gross_charge":8.82,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, esmolol hydrochloride, 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323065210","type":"NDC"}],"standard_charges":[{"gross_charge":137.57,"discounted_cash":34.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eculizumab 300 mg/30 mL solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25682000101","type":"NDC"}],"standard_charges":[{"gross_charge":49966.1,"discounted_cash":12491.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"72266015201","type":"NDC"}],"standard_charges":[{"gross_charge":152.43,"discounted_cash":38.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"71288080651","type":"NDC"}],"standard_charges":[{"gross_charge":141.71,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457079410","type":"NDC"}],"standard_charges":[{"gross_charge":566.84,"discounted_cash":141.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"51991006498","type":"NDC"}],"standard_charges":[{"gross_charge":916.9,"discounted_cash":229.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457061910","type":"NDC"}],"standard_charges":[{"gross_charge":2593.68,"discounted_cash":648.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"63323096600","type":"NDC"}],"standard_charges":[{"gross_charge":2803.56,"discounted_cash":700.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021083082","type":"NDC"}],"standard_charges":[{"gross_charge":1232.49,"discounted_cash":308.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"25021021598","type":"NDC"}],"standard_charges":[{"gross_charge":57.83,"discounted_cash":14.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018822","type":"NDC"}],"standard_charges":[{"gross_charge":201.84,"discounted_cash":50.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"62332075150","type":"NDC"}],"standard_charges":[{"gross_charge":219.08,"discounted_cash":54.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"71288017075","type":"NDC"}],"standard_charges":[{"gross_charge":85.79,"discounted_cash":21.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temsirolimus per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9330","type":"HCPCS"},{"code":"16729022361","type":"NDC"}],"standard_charges":[{"gross_charge":6696.83,"discounted_cash":1674.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temsirolimus per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9330","type":"HCPCS"},{"code":"16729022130","type":"NDC"}],"standard_charges":[{"gross_charge":6696.83,"discounted_cash":1674.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temsirolimus per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9330","type":"HCPCS"},{"code":"8117901","type":"NDC"}],"standard_charges":[{"gross_charge":7469.69,"discounted_cash":1867.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011720","type":"NDC"}],"standard_charges":[{"gross_charge":196.4,"discounted_cash":49.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018723","type":"NDC"}],"standard_charges":[{"gross_charge":104.02,"discounted_cash":26.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018722","type":"NDC"}],"standard_charges":[{"gross_charge":104.02,"discounted_cash":26.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011701","type":"NDC"}],"standard_charges":[{"gross_charge":196.4,"discounted_cash":49.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"23155018631","type":"NDC"}],"standard_charges":[{"gross_charge":2642.7,"discounted_cash":660.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"16729027605","type":"NDC"}],"standard_charges":[{"gross_charge":196.25,"discounted_cash":49.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"gross_charge":88.01,"discounted_cash":22.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018623","type":"NDC"}],"standard_charges":[{"gross_charge":61.13,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018622","type":"NDC"}],"standard_charges":[{"gross_charge":61.13,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011743","type":"NDC"}],"standard_charges":[{"gross_charge":16.47,"discounted_cash":4.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"16729027603","type":"NDC"}],"standard_charges":[{"gross_charge":108.54,"discounted_cash":27.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011718","type":"NDC"}],"standard_charges":[{"gross_charge":16.47,"discounted_cash":4.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011751","type":"NDC"}],"standard_charges":[{"gross_charge":395.26,"discounted_cash":98.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluorouracil per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"16729027667","type":"NDC"}],"standard_charges":[{"gross_charge":196.25,"discounted_cash":49.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"42023011625","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"decitabine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"75834019001","type":"NDC"}],"standard_charges":[{"gross_charge":1006.98,"discounted_cash":251.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"decitabine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"50742043001","type":"NDC"}],"standard_charges":[{"gross_charge":1066.66,"discounted_cash":266.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70069080201","type":"NDC"}],"standard_charges":[{"gross_charge":28.99,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70069080125","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70069080101","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"51754400003","type":"NDC"}],"standard_charges":[{"gross_charge":157.57,"discounted_cash":39.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"51754400001","type":"NDC"}],"standard_charges":[{"gross_charge":157.57,"discounted_cash":39.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"55150030110","type":"NDC"}],"standard_charges":[{"gross_charge":11.95,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"55150030101","type":"NDC"}],"standard_charges":[{"gross_charge":38.41,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"61990021103","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"61990021100","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71288080702","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71288080701","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"641618810","type":"NDC"}],"standard_charges":[{"gross_charge":105.9,"discounted_cash":26.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"641618801","type":"NDC"}],"standard_charges":[{"gross_charge":105.9,"discounted_cash":26.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"63323075101","type":"NDC"}],"standard_charges":[{"gross_charge":30.64,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"63323075100","type":"NDC"}],"standard_charges":[{"gross_charge":30.64,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70069080210","type":"NDC"}],"standard_charges":[{"gross_charge":28.99,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70121157807","type":"NDC"}],"standard_charges":[{"gross_charge":35.43,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70756062125","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70756062210","type":"NDC"}],"standard_charges":[{"gross_charge":16.12,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096510","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096505","type":"NDC"}],"standard_charges":[{"gross_charge":14.09,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096501","type":"NDC"}],"standard_charges":[{"gross_charge":14.09,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096503","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096502","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"409665318","type":"NDC"}],"standard_charges":[{"gross_charge":32.94,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"409665119","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"409663518","type":"NDC"}],"standard_charges":[{"gross_charge":30.95,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"264194020","type":"NDC"}],"standard_charges":[{"gross_charge":180.01,"discounted_cash":45.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"409665106","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"409665305","type":"NDC"}],"standard_charges":[{"gross_charge":32.94,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"409663501","type":"NDC"}],"standard_charges":[{"gross_charge":30.95,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"72205026507","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"72205026501","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70756062285","type":"NDC"}],"standard_charges":[{"gross_charge":16.12,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70756062182","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70121157801","type":"NDC"}],"standard_charges":[{"gross_charge":35.43,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"641622901","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70121157705","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G potassium per 600000 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"gross_charge":221.95,"discounted_cash":55.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G potassium per 600000 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"781613594","type":"NDC"}],"standard_charges":[{"gross_charge":34.08,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"papaverine per 60 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"517400201","type":"NDC"}],"standard_charges":[{"gross_charge":244.11,"discounted_cash":61.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"papaverine per 60 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"72516002401","type":"NDC"}],"standard_charges":[{"gross_charge":237.75,"discounted_cash":59.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"papaverine per 60 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"54288014210","type":"NDC"}],"standard_charges":[{"gross_charge":160.88,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"papaverine per 60 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"54288014201","type":"NDC"}],"standard_charges":[{"gross_charge":160.88,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"papaverine per 60 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"14789012107","type":"NDC"}],"standard_charges":[{"gross_charge":210.27,"discounted_cash":52.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"papaverine per 60 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"14789012105","type":"NDC"}],"standard_charges":[{"gross_charge":210.27,"discounted_cash":52.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"papaverine per 60 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"72516002410","type":"NDC"}],"standard_charges":[{"gross_charge":198.04,"discounted_cash":49.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"papaverine per 60 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"517401001","type":"NDC"}],"standard_charges":[{"gross_charge":170.59,"discounted_cash":42.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin per 10 Units","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"63323001210","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin per 10 Units","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"63323001206","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin per 10 Units","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"63323001211","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin per 10 Units","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"63323001203","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G potassium per 600000 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"49052084","type":"NDC"}],"standard_charges":[{"gross_charge":32.33,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G potassium per 600000 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"49042005","type":"NDC"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":10.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G potassium per 600000 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"70860012620","type":"NDC"}],"standard_charges":[{"gross_charge":31.36,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G potassium per 600000 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"70860012641","type":"NDC"}],"standard_charges":[{"gross_charge":31.36,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70121157701","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"69097053497","type":"NDC"}],"standard_charges":[{"gross_charge":27.53,"discounted_cash":6.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"69097053431","type":"NDC"}],"standard_charges":[{"gross_charge":27.53,"discounted_cash":6.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"76014000433","type":"NDC"}],"standard_charges":[{"gross_charge":100.19,"discounted_cash":25.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"76014000432","type":"NDC"}],"standard_charges":[{"gross_charge":60.59,"discounted_cash":15.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"76014000430","type":"NDC"}],"standard_charges":[{"gross_charge":21.39,"discounted_cash":5.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"641614225","type":"NDC"}],"standard_charges":[{"gross_charge":32.54,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096520","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"641614201","type":"NDC"}],"standard_charges":[{"gross_charge":32.54,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbital 65 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494041503","type":"NDC"}],"standard_charges":[{"gross_charge":168.8,"discounted_cash":42.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbital 65 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"641047621","type":"NDC"}],"standard_charges":[{"gross_charge":101.5,"discounted_cash":25.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbital per 120 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494041601","type":"NDC"}],"standard_charges":[{"gross_charge":344.38,"discounted_cash":86.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbital per 120 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494041625","type":"NDC"}],"standard_charges":[{"gross_charge":344.38,"discounted_cash":86.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbital per 120 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"641047725","type":"NDC"}],"standard_charges":[{"gross_charge":280.63,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbital per 120 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"641047721","type":"NDC"}],"standard_charges":[{"gross_charge":280.63,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G potassium per 600000 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2540","type":"HCPCS"},{"code":"49052083","type":"NDC"}],"standard_charges":[{"gross_charge":32.33,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENobarbital 65 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494041501","type":"NDC"}],"standard_charges":[{"gross_charge":121.95,"discounted_cash":30.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"decitabine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"70121164401","type":"NDC"}],"standard_charges":[{"gross_charge":474.38,"discounted_cash":118.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pralidoxime per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2730","type":"HCPCS"},{"code":"60977014127","type":"NDC"}],"standard_charges":[{"gross_charge":628.59,"discounted_cash":157.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"procainamide per 1 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"14789090107","type":"NDC"}],"standard_charges":[{"gross_charge":4069.3,"discounted_cash":1017.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"64253040091","type":"NDC"}],"standard_charges":[{"gross_charge":84.49,"discounted_cash":21.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"64253040030","type":"NDC"}],"standard_charges":[{"gross_charge":84.49,"discounted_cash":21.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"70121170507","type":"NDC"}],"standard_charges":[{"gross_charge":49.68,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"70121170501","type":"NDC"}],"standard_charges":[{"gross_charge":49.68,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"16729048431","type":"NDC"}],"standard_charges":[{"gross_charge":53.54,"discounted_cash":13.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"76329334001","type":"NDC"}],"standard_charges":[{"gross_charge":141.4,"discounted_cash":35.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"409163015","type":"NDC"}],"standard_charges":[{"gross_charge":74.38,"discounted_cash":18.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"409491011","type":"NDC"}],"standard_charges":[{"gross_charge":128.42,"discounted_cash":32.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"409491134","type":"NDC"}],"standard_charges":[{"gross_charge":133.82,"discounted_cash":33.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine per 0.01 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"409491034","type":"NDC"}],"standard_charges":[{"gross_charge":128.42,"discounted_cash":32.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophilic factor-vWF per 1 VWF:RCo Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"63833062701","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophilic factor-vWF per 1 VWF:RCo Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"63833061702","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophilic factor-vWF per 1 VWF:RCo Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"63833062601","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophilic factor-vWF per 1 VWF:RCo Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"63833061602","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3% per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"264780510","type":"NDC"}],"standard_charges":[{"gross_charge":42.13,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophilic factor-vWF per 1 VWF:RCo Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"63833062501","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3% per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"338005403","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3% per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"63323053075","type":"NDC"}],"standard_charges":[{"gross_charge":15.32,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"decitabine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"16729022405","type":"NDC"}],"standard_charges":[{"gross_charge":354.5,"discounted_cash":88.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"decitabine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"43598042737","type":"NDC"}],"standard_charges":[{"gross_charge":7594.97,"discounted_cash":1898.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"decitabine per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"55111055610","type":"NDC"}],"standard_charges":[{"gross_charge":347.69,"discounted_cash":86.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyaluronidase, human recomb. per 1 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"18657011702","type":"NDC"}],"standard_charges":[{"gross_charge":372.18,"discounted_cash":93.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyaluronidase, human recomb. per 1 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"18657011701","type":"NDC"}],"standard_charges":[{"gross_charge":372.18,"discounted_cash":93.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyaluronidase, human recomb. per 1 Units","drug_information":{"unit":0.02667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"18657010202","type":"NDC"}],"standard_charges":[{"gross_charge":9.86,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hyaluronidase, human recomb. per 1 Units","drug_information":{"unit":0.02667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"18657010204","type":"NDC"}],"standard_charges":[{"gross_charge":9.86,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"gross_charge":8662.27,"discounted_cash":2165.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 16 mg/mL of trimethoprim solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70069036210","type":"NDC"}],"standard_charges":[{"gross_charge":36.23,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 16 mg/mL of trimethoprim solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70069036201","type":"NDC"}],"standard_charges":[{"gross_charge":36.23,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 16 mg/mL of trimethoprim solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"703951481","type":"NDC"}],"standard_charges":[{"gross_charge":64.57,"discounted_cash":16.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 16 mg/mL of trimethoprim solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"703952601","type":"NDC"}],"standard_charges":[{"gross_charge":276.68,"discounted_cash":69.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 16 mg/mL of trimethoprim solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"703951403","type":"NDC"}],"standard_charges":[{"gross_charge":96.06,"discounted_cash":24.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 16 mg/mL of trimethoprim solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"703951401","type":"NDC"}],"standard_charges":[{"gross_charge":96.06,"discounted_cash":24.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium thiosulfate 12.5 gram/50 mL solution 50 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0209","type":"HCPCS"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"gross_charge":379.17,"discounted_cash":94.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3% per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"63323053021","type":"NDC"}],"standard_charges":[{"gross_charge":15.32,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"antihemophilic factor-vWF per 1 VWF:RCo Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7187","type":"HCPCS"},{"code":"63833061502","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"abatacept per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0129","type":"HCPCS"},{"code":"3218713","type":"NDC"}],"standard_charges":[{"gross_charge":11304.86,"discounted_cash":2826.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridoxine per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3415","type":"HCPCS"},{"code":"63323018001","type":"NDC"}],"standard_charges":[{"gross_charge":61.56,"discounted_cash":15.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"83634077841","type":"NDC"}],"standard_charges":[{"gross_charge":29.87,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"83634077802","type":"NDC"}],"standard_charges":[{"gross_charge":29.87,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"72266020410","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"72266020401","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"70121158005","type":"NDC"}],"standard_charges":[{"gross_charge":31.42,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"70121158001","type":"NDC"}],"standard_charges":[{"gross_charge":31.42,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"713035125","type":"NDC"}],"standard_charges":[{"gross_charge":35.63,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"713035102","type":"NDC"}],"standard_charges":[{"gross_charge":38.04,"discounted_cash":9.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"25021079002","type":"NDC"}],"standard_charges":[{"gross_charge":17.62,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"43066009025","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":4.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"43066009001","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"67457064002","type":"NDC"}],"standard_charges":[{"gross_charge":170.05,"discounted_cash":42.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"67457064000","type":"NDC"}],"standard_charges":[{"gross_charge":170.05,"discounted_cash":42.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"procainamide per 1 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"409190211","type":"NDC"}],"standard_charges":[{"gross_charge":961.1,"discounted_cash":240.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"procainamide per 1 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"14789090110","type":"NDC"}],"standard_charges":[{"gross_charge":4069.3,"discounted_cash":1017.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"65145011901","type":"NDC"}],"standard_charges":[{"gross_charge":32.11,"discounted_cash":8.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, prochlorperazine, up to 10 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"65145011910","type":"NDC"}],"standard_charges":[{"gross_charge":32.11,"discounted_cash":8.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 50 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"641092821","type":"NDC"}],"standard_charges":[{"gross_charge":24.11,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 50 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"641149531","type":"NDC"}],"standard_charges":[{"gross_charge":17.71,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridoxine per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3415","type":"HCPCS"},{"code":"63323018000","type":"NDC"}],"standard_charges":[{"gross_charge":61.56,"discounted_cash":15.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"protamine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022930","type":"NDC"}],"standard_charges":[{"gross_charge":237.27,"discounted_cash":59.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"protamine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"gross_charge":79.01,"discounted_cash":19.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"protamine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022901","type":"NDC"}],"standard_charges":[{"gross_charge":79.01,"discounted_cash":19.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"protamine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022995","type":"NDC"}],"standard_charges":[{"gross_charge":202.8,"discounted_cash":50.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 12.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"904730461","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 12.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"904646161","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"procainamide per 1 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"409190201","type":"NDC"}],"standard_charges":[{"gross_charge":961.1,"discounted_cash":240.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 12.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"68084015511","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"641620825","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 50 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"641620801","type":"NDC"}],"standard_charges":[{"gross_charge":12.84,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"39822552503","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 50 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"39822552502","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"641608425","type":"NDC"}],"standard_charges":[{"gross_charge":24.04,"discounted_cash":6.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"641608401","type":"NDC"}],"standard_charges":[{"gross_charge":24.04,"discounted_cash":6.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"641608201","type":"NDC"}],"standard_charges":[{"gross_charge":31.51,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine per 12.5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0169","type":"HCPCS"},{"code":"68084015501","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diatrizoate meglumine-sodium per 1 mL","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"270044535","type":"NDC"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":51.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bevacizumab-awwb 25 mg/mL solution 16 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"gross_charge":13237.46,"discounted_cash":3309.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"polatuzumab vedotin-piiq 140 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9309","type":"HCPCS"},{"code":"50242010501","type":"NDC"}],"standard_charges":[{"gross_charge":142206.98,"discounted_cash":35551.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687040411","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862084401","type":"NDC"}],"standard_charges":[{"gross_charge":2.25,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93435993","type":"NDC"}],"standard_charges":[{"gross_charge":5.21,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93435919","type":"NDC"}],"standard_charges":[{"gross_charge":5.21,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079092201","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708761","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687041511","type":"NDC"}],"standard_charges":[{"gross_charge":4.26,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862084601","type":"NDC"}],"standard_charges":[{"gross_charge":3.79,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93777219","type":"NDC"}],"standard_charges":[{"gross_charge":11.68,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93777201","type":"NDC"}],"standard_charges":[{"gross_charge":12.84,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 10 mg troche 70 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574010777","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 10 mg troche 70 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574010770","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 10 mg troche 70 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54814622","type":"NDC"}],"standard_charges":[{"gross_charge":14.43,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clotrimazole 10 mg troche 70 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54414622","type":"NDC"}],"standard_charges":[{"gross_charge":11.98,"discounted_cash":3.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079088301","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904708961","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 2 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268017515","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cloZAPine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079092101","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 10 mcg/mL (400 unit/mL) drops 50 mL DROP BTL","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"87086644","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate 2 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478009710","type":"NDC"}],"standard_charges":[{"gross_charge":50.36,"discounted_cash":12.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate 2 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478009702","type":"NDC"}],"standard_charges":[{"gross_charge":89.5,"discounted_cash":22.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 100 mg tablet 60 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904724568","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":2.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 100 mg tablet 60 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"131247860","type":"NDC"}],"standard_charges":[{"gross_charge":83.54,"discounted_cash":20.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 50 mg tablet 60 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904724468","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 50 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335091886","type":"NDC"}],"standard_charges":[{"gross_charge":2.45,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lacosamide 50 mg tablet 60 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"131247760","type":"NDC"}],"standard_charges":[{"gross_charge":53.79,"discounted_cash":13.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"armodafinil 250 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862080730","type":"NDC"}],"standard_charges":[{"gross_charge":5.53,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"artemether-lumefantrine 20-120 mg tablet 24 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78056845","type":"NDC"}],"standard_charges":[{"gross_charge":23.32,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 10 mcg/mL (400 unit/mL) drops 50 mL DROP BTL","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69618001959","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"collagenase 250 unit/gram ointment 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"50484001030","type":"NDC"}],"standard_charges":[{"gross_charge":1157.81,"discounted_cash":289.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate 2 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65039702","type":"NDC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":43.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268017511","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904610361","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clobetasol 0.05 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672125801","type":"NDC"}],"standard_charges":[{"gross_charge":51.22,"discounted_cash":12.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clindamycin 2 % cream 40 g TUBE/KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168027740","type":"NDC"}],"standard_charges":[{"gross_charge":317.18,"discounted_cash":79.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clarithromycin 500 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904687204","type":"NDC"}],"standard_charges":[{"gross_charge":8.91,"discounted_cash":2.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clarithromycin 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268017911","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clarithromycin 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084065195","type":"NDC"}],"standard_charges":[{"gross_charge":14.99,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clarithromycin 500 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237004560","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clarithromycin 500 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781196260","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clarithromycin 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268017815","type":"NDC"}],"standard_charges":[{"gross_charge":9.11,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clarithromycin 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268017811","type":"NDC"}],"standard_charges":[{"gross_charge":9.11,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clarithromycin 250 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237004460","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clarithromycin 250 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781196160","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65065605","type":"NDC"}],"standard_charges":[{"gross_charge":472.67,"discounted_cash":118.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69315030805","type":"NDC"}],"standard_charges":[{"gross_charge":39.52,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 0.3 % drops 2.5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69315030802","type":"NDC"}],"standard_charges":[{"gross_charge":31.46,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478071410","type":"NDC"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":14.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clobetasol 0.05 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672125901","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":3.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547040810","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739026310","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547040610","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079088201","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888015301","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 1 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268017415","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268017411","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904772861","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055511","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687055501","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547040710","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729013700","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 0.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888015201","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 0.5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268017315","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268017311","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904722761","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687054411","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687054401","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clonazePAM 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904610161","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate 2 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65039705","type":"NDC"}],"standard_charges":[{"gross_charge":286.06,"discounted_cash":71.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexlansoprazole 30 mg capsule,biphase delayed releas 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764017130","type":"NDC"}],"standard_charges":[{"gross_charge":74.53,"discounted_cash":18.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cyclopentolate-phenylephrine 0.2-1 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65035902","type":"NDC"}],"standard_charges":[{"gross_charge":138.1,"discounted_cash":34.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079095801","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832035711","type":"NDC"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729041401","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904552361","type":"NDC"}],"standard_charges":[{"gross_charge":3.19,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084085195","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 2 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084085125","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079095701","type":"NDC"}],"standard_charges":[{"gross_charge":11.41,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904552261","type":"NDC"}],"standard_charges":[{"gross_charge":3.15,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904715361","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806071401","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332042631","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904656461","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687034611","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687034601","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877057301","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 4 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729021301","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739002910","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 4 MG tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729021317","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 4 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904552461","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalapril 10 MG tablet 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155077210","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalapril 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155077201","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 2.5 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904714461","type":"NDC"}],"standard_charges":[{"gross_charge":42.64,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 2.5 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877075360","type":"NDC"}],"standard_charges":[{"gross_charge":9.28,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 2.5 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904674561","type":"NDC"}],"standard_charges":[{"gross_charge":14.1,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 2.5 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687037511","type":"NDC"}],"standard_charges":[{"gross_charge":19.71,"discounted_cash":4.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 2.5 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687037501","type":"NDC"}],"standard_charges":[{"gross_charge":20.24,"discounted_cash":5.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 2.5 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858086706","type":"NDC"}],"standard_charges":[{"gross_charge":11.56,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 2.5 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904659761","type":"NDC"}],"standard_charges":[{"gross_charge":16.14,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 2.5 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877056860","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 2.5 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084017411","type":"NDC"}],"standard_charges":[{"gross_charge":17.04,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 10 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877075560","type":"NDC"}],"standard_charges":[{"gross_charge":19.54,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"droNABinol 10 MG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884086902","type":"NDC"}],"standard_charges":[{"gross_charge":46.03,"discounted_cash":11.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen 80 MG tablet,chewable 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904579146","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 4 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079095901","type":"NDC"}],"standard_charges":[{"gross_charge":13.18,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"doxazosin 4 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084086295","type":"NDC"}],"standard_charges":[{"gross_charge":5.11,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084021411","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084021401","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzonatate 100 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877010501","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin-dextromethorphan 10-100 mg/5 mL syrup 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69339015001","type":"NDC"}],"standard_charges":[{"gross_charge":7.06,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin-dextromethorphan 10-100 mg/5 mL syrup 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121127610","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"demeclocycline 150 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687069111","type":"NDC"}],"standard_charges":[{"gross_charge":28.04,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"demeclocycline 150 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687069101","type":"NDC"}],"standard_charges":[{"gross_charge":28.04,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"demeclocycline 150 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806014301","type":"NDC"}],"standard_charges":[{"gross_charge":22.87,"discounted_cash":5.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"demeclocycline 150 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584015911","type":"NDC"}],"standard_charges":[{"gross_charge":23.52,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dantrolene 50 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115442201","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dantrolene 25 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904721104","type":"NDC"}],"standard_charges":[{"gross_charge":6.83,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dantrolene 25 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084030021","type":"NDC"}],"standard_charges":[{"gross_charge":7.52,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dantrolene 25 MG capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084030011","type":"NDC"}],"standard_charges":[{"gross_charge":7.52,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"febuxostat 40 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764091830","type":"NDC"}],"standard_charges":[{"gross_charge":43.73,"discounted_cash":10.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"78011022","type":"NDC"}],"standard_charges":[{"gross_charge":3270.54,"discounted_cash":817.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"68084087995","type":"NDC"}],"standard_charges":[{"gross_charge":19.16,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"68084087925","type":"NDC"}],"standard_charges":[{"gross_charge":19.16,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloSPORINE per 25 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7515","type":"HCPCS"},{"code":"78024061","type":"NDC"}],"standard_charges":[{"gross_charge":18.83,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin-dextromethorphan 10-100 mg/5 mL syrup 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69339015019","type":"NDC"}],"standard_charges":[{"gross_charge":7.06,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 15 mg tablet 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148002050","type":"NDC"}],"standard_charges":[{"gross_charge":2184.83,"discounted_cash":546.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 15 mg tablet 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505470400","type":"NDC"}],"standard_charges":[{"gross_charge":1471.76,"discounted_cash":367.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 15 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505470402","type":"NDC"}],"standard_charges":[{"gross_charge":1471.76,"discounted_cash":367.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prasugreL HCl 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687088311","type":"NDC"}],"standard_charges":[{"gross_charge":9.84,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prasugreL HCl 10 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505464303","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prasugreL HCl 10 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"2512301","type":"NDC"}],"standard_charges":[{"gross_charge":60.8,"discounted_cash":15.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dronedarone 400 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24414210","type":"NDC"}],"standard_charges":[{"gross_charge":43.03,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tapentadoL 100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510010010","type":"NDC"}],"standard_charges":[{"gross_charge":75.35,"discounted_cash":18.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tapentadoL 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510005010","type":"NDC"}],"standard_charges":[{"gross_charge":48.39,"discounted_cash":12.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tapentadoL 50 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458082002","type":"NDC"}],"standard_charges":[{"gross_charge":17.38,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin HCl 0.3 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314065605","type":"NDC"}],"standard_charges":[{"gross_charge":54.68,"discounted_cash":13.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 30 mg tablet 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884077054","type":"NDC"}],"standard_charges":[{"gross_charge":408.27,"discounted_cash":102.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 30 mg tablet 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722086903","type":"NDC"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":126.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 30 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722086901","type":"NDC"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":126.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 30 mg tablet 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148002150","type":"NDC"}],"standard_charges":[{"gross_charge":2266.5,"discounted_cash":566.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 15 mg tablet 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877063533","type":"NDC"}],"standard_charges":[{"gross_charge":337.42,"discounted_cash":84.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 15 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722086831","type":"NDC"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":63.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 15 mg tablet 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884076854","type":"NDC"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":47.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 15 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884076852","type":"NDC"}],"standard_charges":[{"gross_charge":190.81,"discounted_cash":47.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolvaptan 30 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884077052","type":"NDC"}],"standard_charges":[{"gross_charge":408.27,"discounted_cash":102.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorothiazide 250 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":0.04219,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213405","type":"NDC"}],"standard_charges":[{"gross_charge":11.38,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorothiazide 250 mg/5 mL suspension 237 mL Bottle","drug_information":{"unit":0.04219,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65649031112","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorhexidine 0.12 % mouthwash 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689010650","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuterol per 3 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"378967131","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuterol per 3 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"378967193","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuterol per 3 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204060001","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuterol per 3 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487020101","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg tablet,chewable 500 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66553000401","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg tablet,chewable 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433010601","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg tablet,chewable 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084098833","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg tablet,chewable 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084098832","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium carbonate 500 mg tablet,chewable 150 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536100715","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitrioL 0.25 MCG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687034511","type":"NDC"}],"standard_charges":[{"gross_charge":3.98,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitrioL 0.25 MCG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687034501","type":"NDC"}],"standard_charges":[{"gross_charge":3.98,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitrioL 0.25 MCG capsule 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155066203","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitrioL 0.25 MCG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155066201","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitrioL 0.25 MCG capsule 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54000713","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitonin per 400 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"78014923","type":"NDC"}],"standard_charges":[{"gross_charge":7867.02,"discounted_cash":1966.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuterol per 3 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69097017348","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitonin per 400 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"25021047302","type":"NDC"}],"standard_charges":[{"gross_charge":1774.54,"discounted_cash":443.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuterol per 3 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69097017353","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuterol per 3 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687040583","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228253910","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 10-100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228045701","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 10-100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739010710","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 10-100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756051788","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 10-100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228253810","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"captopril 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241016201","type":"NDC"}],"standard_charges":[{"gross_charge":3.28,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"captopril 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378301701","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"captopril 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"143117301","type":"NDC"}],"standard_charges":[{"gross_charge":7.36,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"captopril 12.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904504561","type":"NDC"}],"standard_charges":[{"gross_charge":5.03,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"captopril 12.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079086301","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"captopril 12.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904710561","type":"NDC"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"captopril 12.5 MG tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687030421","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"captopril 12.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687030411","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"capsaicin 0.075 % cream 57 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536111825","type":"NDC"}],"standard_charges":[{"gross_charge":19.63,"discounted_cash":4.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuterol per 3 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69097084087","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipratropium-albuterol per 3 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60687040579","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitonin per 400 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"43598005111","type":"NDC"}],"standard_charges":[{"gross_charge":1819.4,"discounted_cash":454.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitonin per 400 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"42023020501","type":"NDC"}],"standard_charges":[{"gross_charge":2579.98,"discounted_cash":645.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitonin per 400 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"24201040002","type":"NDC"}],"standard_charges":[{"gross_charge":3035.13,"discounted_cash":758.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion 75 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268014211","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion 75 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739070610","type":"NDC"}],"standard_charges":[{"gross_charge":4.33,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion 75 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505015801","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079094401","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904663661","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bumetanide 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904701661","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bumetanide 1 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904701606","type":"NDC"}],"standard_charges":[{"gross_charge":4.21,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bumetanide 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687038411","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bumetanide 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687038401","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bumetanide 1 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268013115","type":"NDC"}],"standard_charges":[{"gross_charge":4.72,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bumetanide 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268013111","type":"NDC"}],"standard_charges":[{"gross_charge":4.72,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bumetanide 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238149001","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bumetanide 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"185012901","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bromocriptine 2.5 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687028621","type":"NDC"}],"standard_charges":[{"gross_charge":25.06,"discounted_cash":6.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bromocriptine 2.5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687028611","type":"NDC"}],"standard_charges":[{"gross_charge":25.06,"discounted_cash":6.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion 75 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687034001","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion 75 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687034011","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion 75 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904663561","type":"NDC"}],"standard_charges":[{"gross_charge":4.77,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buPROPion 75 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079094301","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcitonin per 400 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"67457067502","type":"NDC"}],"standard_charges":[{"gross_charge":7807.8,"discounted_cash":1951.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904712261","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300024401","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155002301","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 5 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729020016","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729020001","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 5 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382018005","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084009311","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380074106","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904712161","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155002401","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24689090701","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 10 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729020216","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729020201","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382018101","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079098601","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"busPIRone 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079098501","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalapril 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904731161","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756051888","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6391668","type":"NDC"}],"standard_charges":[{"gross_charge":5.56,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 500 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93314701","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 500 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904733761","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 500 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904733735","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 500 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687016311","type":"NDC"}],"standard_charges":[{"gross_charge":2.46,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 500 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268015211","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 500 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268015215","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 500 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877021901","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93314501","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 250 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904733661","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 250 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687015211","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 250 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687015201","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 250 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268015111","type":"NDC"}],"standard_charges":[{"gross_charge":2.39,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877022001","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 250 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862001801","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefuroxime 500 MG tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862070020","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 125 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710201905","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefuroxime 500 MG tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180030320","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 125 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24979015414","type":"NDC"}],"standard_charges":[{"gross_charge":31.08,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 125 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710215205","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorhexidine 0.12 % mouthwash 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689010601","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorhexidine 0.12 % mouthwash 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"69339013815","type":"NDC"}],"standard_charges":[{"gross_charge":5.61,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorhexidine 0.12 % mouthwash 15 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17856200203","type":"NDC"}],"standard_charges":[{"gross_charge":2.46,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorambuciL 2 mg tablet 25 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76388063525","type":"NDC"}],"standard_charges":[{"gross_charge":108.59,"discounted_cash":27.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephALEXin 250 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93417773","type":"NDC"}],"standard_charges":[{"gross_charge":52.08,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephALEXin 250 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710215405","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephALEXin 250 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710215105","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephALEXin 250 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"67877054588","type":"NDC"}],"standard_charges":[{"gross_charge":49.98,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephALEXin 250 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24979015514","type":"NDC"}],"standard_charges":[{"gross_charge":32.34,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephALEXin 250 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"68180044101","type":"NDC"}],"standard_charges":[{"gross_charge":51.24,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephALEXin 250 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710202105","type":"NDC"}],"standard_charges":[{"gross_charge":4.03,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephALEXin 250 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710202005","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 125 mg/5 mL suspension for reconstitution 200 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93417574","type":"NDC"}],"standard_charges":[{"gross_charge":125.16,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 125 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"93417573","type":"NDC"}],"standard_charges":[{"gross_charge":45.78,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 125 mg/5 mL suspension for reconstitution 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710215305","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cephalexin 125 mg/5 mL suspension for reconstitution 100 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"67877054488","type":"NDC"}],"standard_charges":[{"gross_charge":36.54,"discounted_cash":9.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefuroxime 250 MG tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687027294","type":"NDC"}],"standard_charges":[{"gross_charge":17.59,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefuroxime 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687027211","type":"NDC"}],"standard_charges":[{"gross_charge":17.59,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefuroxime 250 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862069960","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-250 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93970301","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-250 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687083611","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-250 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687083601","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-250 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862085801","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-250 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904623861","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-250 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084009411","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-250 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228254010","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904750161","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904725761","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687066111","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687066101","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93970201","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739001710","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862007901","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904623761","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 15-3.6 mg lozenge 18 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904625549","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 15-3.6 mg lozenge 16 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824071016","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 15-3.6 mg lozenge 16 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824071316","type":"NDC"}],"standard_charges":[{"gross_charge":0.81,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 15-3.6 mg lozenge 16 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824072283","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefuroxime 250 MG tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862069920","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefuroxime 250 MG tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237005820","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefuroxime 250 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180030260","type":"NDC"}],"standard_charges":[{"gross_charge":11.92,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefuroxime 250 MG tablet 20 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180030220","type":"NDC"}],"standard_charges":[{"gross_charge":12.38,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 2,000 INT'L UNITS tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681017000","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 2,000 INT'L UNITS tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681013200","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 2,000 INT'L UNITS tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9046015760","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carbidopa-levodopa 25-100 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079088401","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 2,000 INT'L UNITS tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268086515","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 2,000 INT'L UNITS tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"79854004112","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 2,000 INT'L UNITS tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31604002673","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 2,000 INT'L UNITS tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904615760","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 2,000 INT'L UNITS tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54629041120","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 15-3.6 mg lozenge 18 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000055401","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 15-3.6 mg lozenge 16 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824071516","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzocaine-menthoL 15-3.6 mg lozenge 16 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824072482","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cholecalciferol (vitamin D3) 2,000 INT'L UNITS tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268086511","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalapril 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079095201","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalapril 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904561061","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalapril 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904550261","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409317801","type":"NDC"}],"standard_charges":[{"gross_charge":17.01,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048101","type":"NDC"}],"standard_charges":[{"gross_charge":66.26,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409317716","type":"NDC"}],"standard_charges":[{"gross_charge":27.96,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048157","type":"NDC"}],"standard_charges":[{"gross_charge":66.26,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 0.5 %-1:200000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409317701","type":"NDC"}],"standard_charges":[{"gross_charge":27.96,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049504","type":"NDC"}],"standard_charges":[{"gross_charge":26.04,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049541","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409206610","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409428212","type":"NDC"}],"standard_charges":[{"gross_charge":19.07,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049526","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150016505","type":"NDC"}],"standard_charges":[{"gross_charge":7.28,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049507","type":"NDC"}],"standard_charges":[{"gross_charge":26.04,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049697","type":"NDC"}],"standard_charges":[{"gross_charge":49.48,"discounted_cash":12.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409206605","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150016300","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409317802","type":"NDC"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":6.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150016209","type":"NDC"}],"standard_charges":[{"gross_charge":7.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409317803","type":"NDC"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048217","type":"NDC"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 1.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048837","type":"NDC"}],"standard_charges":[{"gross_charge":129.38,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 1.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048831","type":"NDC"}],"standard_charges":[{"gross_charge":53.08,"discounted_cash":13.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 1.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409318101","type":"NDC"}],"standard_charges":[{"gross_charge":67.1,"discounted_cash":16.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine (PF) 1 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048701","type":"NDC"}],"standard_charges":[{"gross_charge":80.05,"discounted_cash":20.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine (PF) 1 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048707","type":"NDC"}],"standard_charges":[{"gross_charge":111.45,"discounted_cash":27.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine (PF) 1 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048717","type":"NDC"}],"standard_charges":[{"gross_charge":80.05,"discounted_cash":20.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409317818","type":"NDC"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409317817","type":"NDC"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":6.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409317816","type":"NDC"}],"standard_charges":[{"gross_charge":17.01,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048205","type":"NDC"}],"standard_charges":[{"gross_charge":94.22,"discounted_cash":23.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048201","type":"NDC"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048241","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048203","type":"NDC"}],"standard_charges":[{"gross_charge":40.6,"discounted_cash":10.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048226","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":40.6,"discounted_cash":10.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 1 %-1:100000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048257","type":"NDC"}],"standard_charges":[{"gross_charge":94.22,"discounted_cash":23.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"31722011733","type":"NDC"}],"standard_charges":[{"gross_charge":33.32,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"31722011730","type":"NDC"}],"standard_charges":[{"gross_charge":33.32,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70756064185","type":"NDC"}],"standard_charges":[{"gross_charge":12.91,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150016330","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150016205","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"gross_charge":6.31,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049227","type":"NDC"}],"standard_charges":[{"gross_charge":17.11,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049257","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF 10 mg/mL (1 %) elastomeric pump,fixed rate 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049237","type":"NDC"}],"standard_charges":[{"gross_charge":85.49,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049231","type":"NDC"}],"standard_charges":[{"gross_charge":67.56,"discounted_cash":16.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409471332","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF 10 mg/mL (1 %) elastomeric pump,fixed rate 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427902","type":"NDC"}],"standard_charges":[{"gross_charge":20.68,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosulfan blue per 50 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"55150024005","type":"NDC"}],"standard_charges":[{"gross_charge":250.73,"discounted_cash":62.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosulfan blue per 50 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022000","type":"NDC"}],"standard_charges":[{"gross_charge":1041.02,"discounted_cash":260.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"isosulfan blue per 50 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"gross_charge":1041.02,"discounted_cash":260.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iohexol per 1 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9965","type":"HCPCS"},{"code":"407141120","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":17.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ifosfamide per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"338399301","type":"NDC"}],"standard_charges":[{"gross_charge":781.4,"discounted_cash":195.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ifosfamide per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"10019092616","type":"NDC"}],"standard_charges":[{"gross_charge":663.74,"discounted_cash":165.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049216","type":"NDC"}],"standard_charges":[{"gross_charge":6.63,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049236","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049226","type":"NDC"}],"standard_charges":[{"gross_charge":14.02,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427916","type":"NDC"}],"standard_charges":[{"gross_charge":20.68,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70756064125","type":"NDC"}],"standard_charges":[{"gross_charge":12.91,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70756064082","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70756064025","type":"NDC"}],"standard_charges":[{"gross_charge":8.89,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71351002125","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71351002105","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409471325","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049204","type":"NDC"}],"standard_charges":[{"gross_charge":17.11,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 1.5 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048817","type":"NDC"}],"standard_charges":[{"gross_charge":79.2,"discounted_cash":19.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049209","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049243","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049207","type":"NDC"}],"standard_charges":[{"gross_charge":85.49,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049245","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF 10 mg/mL (1 %) elastomeric pump,fixed rate 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143959525","type":"NDC"}],"standard_charges":[{"gross_charge":8.69,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF 10 mg/mL (1 %) elastomeric pump,fixed rate 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143959501","type":"NDC"}],"standard_charges":[{"gross_charge":8.69,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409471342","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409471312","type":"NDC"}],"standard_charges":[{"gross_charge":6.89,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049641","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ifosfamide per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"10019092602","type":"NDC"}],"standard_charges":[{"gross_charge":663.74,"discounted_cash":165.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 1.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409318111","type":"NDC"}],"standard_charges":[{"gross_charge":67.1,"discounted_cash":16.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 1.5 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048801","type":"NDC"}],"standard_charges":[{"gross_charge":79.2,"discounted_cash":19.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"31722027630","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70594011702","type":"NDC"}],"standard_charges":[{"gross_charge":21.52,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70594011701","type":"NDC"}],"standard_charges":[{"gross_charge":21.52,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143933410","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143933401","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046601","type":"NDC"}],"standard_charges":[{"gross_charge":73.77,"discounted_cash":18.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046603","type":"NDC"}],"standard_charges":[{"gross_charge":43.74,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409116218","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409116219","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409156019","type":"NDC"}],"standard_charges":[{"gross_charge":36.54,"discounted_cash":9.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409156018","type":"NDC"}],"standard_charges":[{"gross_charge":34.32,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150017030","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150016910","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046617","type":"NDC"}],"standard_charges":[{"gross_charge":43.74,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046637","type":"NDC"}],"standard_charges":[{"gross_charge":73.77,"discounted_cash":18.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"31722027634","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046631","type":"NDC"}],"standard_charges":[{"gross_charge":39.53,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cabazitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9043","type":"HCPCS"},{"code":"24582411","type":"NDC"}],"standard_charges":[{"gross_charge":109712.87,"discounted_cash":27428.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine per 0.2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"517074020","type":"NDC"}],"standard_charges":[{"gross_charge":161.98,"discounted_cash":40.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"703853021","type":"NDC"}],"standard_charges":[{"gross_charge":67.32,"discounted_cash":16.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75801301","type":"NDC"}],"standard_charges":[{"gross_charge":17.56,"discounted_cash":4.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955100310","type":"NDC"}],"standard_charges":[{"gross_charge":45.7,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"548560100","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sodium succinate per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"43598012811","type":"NDC"}],"standard_charges":[{"gross_charge":100.5,"discounted_cash":25.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sodium succinate per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"143985001","type":"NDC"}],"standard_charges":[{"gross_charge":119.42,"discounted_cash":29.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sodium succinate per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9075801","type":"NDC"}],"standard_charges":[{"gross_charge":175.64,"discounted_cash":43.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sodium succinate per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"43598013074","type":"NDC"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":22.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sodium succinate per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"143985101","type":"NDC"}],"standard_charges":[{"gross_charge":340.79,"discounted_cash":85.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sodium succinate per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9069802","type":"NDC"}],"standard_charges":[{"gross_charge":170.89,"discounted_cash":42.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sodium succinate per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9069801","type":"NDC"}],"standard_charges":[{"gross_charge":318.5,"discounted_cash":79.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sodium succinate per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"63323026530","type":"NDC"}],"standard_charges":[{"gross_charge":86.4,"discounted_cash":21.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine per 0.2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"51991014499","type":"NDC"}],"standard_charges":[{"gross_charge":119.26,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine per 0.2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"51991014417","type":"NDC"}],"standard_charges":[{"gross_charge":119.26,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylergonovine per 0.2 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2210","type":"HCPCS"},{"code":"517074001","type":"NDC"}],"standard_charges":[{"gross_charge":161.98,"discounted_cash":40.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cabazitaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9043","type":"HCPCS"},{"code":"24582315","type":"NDC"}],"standard_charges":[{"gross_charge":109712.87,"discounted_cash":27428.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409116202","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409156029","type":"NDC"}],"standard_charges":[{"gross_charge":36.54,"discounted_cash":9.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409156010","type":"NDC"}],"standard_charges":[{"gross_charge":34.32,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 2 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048901","type":"NDC"}],"standard_charges":[{"gross_charge":84.87,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 2 %-1:200000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409318311","type":"NDC"}],"standard_charges":[{"gross_charge":36.31,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 2 %-1:200000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048902","type":"NDC"}],"standard_charges":[{"gross_charge":40.14,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 2 %-1:200000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"gross_charge":170.36,"discounted_cash":42.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 2 %-1:200000 solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048917","type":"NDC"}],"standard_charges":[{"gross_charge":84.87,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 2 %-1:200000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048921","type":"NDC"}],"standard_charges":[{"gross_charge":46.27,"discounted_cash":11.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 2 %-1:200000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409318301","type":"NDC"}],"standard_charges":[{"gross_charge":36.31,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 2 %-1:100000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409318231","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 2 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409318211","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 2 %-1:100000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048301","type":"NDC"}],"standard_charges":[{"gross_charge":76.6,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 2 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048303","type":"NDC"}],"standard_charges":[{"gross_charge":41.21,"discounted_cash":10.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 2 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048327","type":"NDC"}],"standard_charges":[{"gross_charge":41.21,"discounted_cash":10.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 2 %-1:100000 solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048357","type":"NDC"}],"standard_charges":[{"gross_charge":76.6,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 2 %-1:100000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409318202","type":"NDC"}],"standard_charges":[{"gross_charge":37.69,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine 2 %-1:100000 solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409318201","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melphalan HCl per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9245","type":"HCPCS"},{"code":"67457019501","type":"NDC"}],"standard_charges":[{"gross_charge":543.71,"discounted_cash":135.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mepivacaine 15 mg/mL (1.5 %) solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"409104130","type":"NDC"}],"standard_charges":[{"gross_charge":37.69,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesna per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"10019095301","type":"NDC"}],"standard_charges":[{"gross_charge":61.66,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesna per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"10019095362","type":"NDC"}],"standard_charges":[{"gross_charge":61.66,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mepivacaine PF per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323029401","type":"NDC"}],"standard_charges":[{"gross_charge":112.14,"discounted_cash":28.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mepivacaine PF per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"409106720","type":"NDC"}],"standard_charges":[{"gross_charge":33.86,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"denosumab per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"gross_charge":13597.19,"discounted_cash":3399.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"denosumab per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513071001","type":"NDC"}],"standard_charges":[{"gross_charge":12334.44,"discounted_cash":3083.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin, porcine (PF) per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253022235","type":"NDC"}],"standard_charges":[{"gross_charge":3.41,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin, porcine (PF) per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306510","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin, porcine (PF) per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306414","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine-EPINEPHrine PF 1.5 %-1:200000 solution 30 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323048807","type":"NDC"}],"standard_charges":[{"gross_charge":129.38,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"97710512901","type":"NDC"}],"standard_charges":[{"gross_charge":54.18,"discounted_cash":13.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"17478038020","type":"NDC"}],"standard_charges":[{"gross_charge":2167.32,"discounted_cash":541.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"67457021720","type":"NDC"}],"standard_charges":[{"gross_charge":3068.44,"discounted_cash":767.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457046302","type":"NDC"}],"standard_charges":[{"gross_charge":1321.35,"discounted_cash":330.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"409018701","type":"NDC"}],"standard_charges":[{"gross_charge":822.38,"discounted_cash":205.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesna per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"63323073310","type":"NDC"}],"standard_charges":[{"gross_charge":430.34,"discounted_cash":107.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesna per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"25021020110","type":"NDC"}],"standard_charges":[{"gross_charge":61.66,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mesna per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"338130501","type":"NDC"}],"standard_charges":[{"gross_charge":61.66,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methadone per 10 mg","drug_information":{"unit":0.025,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"97710512801","type":"NDC"}],"standard_charges":[{"gross_charge":69.33,"discounted_cash":17.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bromocriptine 2.5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574010603","type":"NDC"}],"standard_charges":[{"gross_charge":9.14,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ifosfamide per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"63323014210","type":"NDC"}],"standard_charges":[{"gross_charge":188.44,"discounted_cash":47.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ifosfamide per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"10019092501","type":"NDC"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":68.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"338604648","type":"NDC"}],"standard_charges":[{"gross_charge":52.09,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim per 1 mcg, excludes biosimilars","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513053010","type":"NDC"}],"standard_charges":[{"gross_charge":2348.98,"discounted_cash":587.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim per 1 mcg, excludes biosimilars","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513053001","type":"NDC"}],"standard_charges":[{"gross_charge":2348.98,"discounted_cash":587.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetic acid 0.25 % solution 1,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"338065604","type":"NDC"}],"standard_charges":[{"gross_charge":84.26,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetic acid 0.25 % solution 1,000 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"264230400","type":"NDC"}],"standard_charges":[{"gross_charge":76.6,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin B GU 40 mg-200,000 unit/mL solution 1 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"39822120101","type":"NDC"}],"standard_charges":[{"gross_charge":84.52,"discounted_cash":21.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin B GU 40 mg-200,000 unit/mL solution 1 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"591219054","type":"NDC"}],"standard_charges":[{"gross_charge":45.33,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin B GU 40 mg-200,000 unit/mL solution 1 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"39822120105","type":"NDC"}],"standard_charges":[{"gross_charge":71.77,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-polymyxin B GU 40 mg-200,000 unit/mL solution 1 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"39822120102","type":"NDC"}],"standard_charges":[{"gross_charge":84.52,"discounted_cash":21.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorhexidine 4 % liquid 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"116299404","type":"NDC"}],"standard_charges":[{"gross_charge":14.46,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorhexidine 4 % liquid 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"116106104","type":"NDC"}],"standard_charges":[{"gross_charge":53.33,"discounted_cash":13.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorhexidine 4 % liquid 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"67618020004","type":"NDC"}],"standard_charges":[{"gross_charge":48.81,"discounted_cash":12.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorhexidine 4 % liquid 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"52380127204","type":"NDC"}],"standard_charges":[{"gross_charge":15.37,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc oxide-petrolatum 20-51 % paste 71 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"259","type":"RC"},{"code":"11701005033","type":"NDC"}],"standard_charges":[{"gross_charge":29.22,"discounted_cash":7.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"36000000206","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sod borate-boric ac-NaCl-water irrigation solution 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"259","type":"RC"},{"code":"70000001801","type":"NDC"}],"standard_charges":[{"gross_charge":18.08,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"36000000210","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":29.11,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ganciclovir per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"63323031510","type":"NDC"}],"standard_charges":[{"gross_charge":909.01,"discounted_cash":227.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibutilide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"23155032631","type":"NDC"}],"standard_charges":[{"gross_charge":4288.22,"discounted_cash":1072.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ibutilide per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"9379401","type":"NDC"}],"standard_charges":[{"gross_charge":1254.78,"discounted_cash":313.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fludarabine 50 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9185","type":"HCPCS"},{"code":"24201023701","type":"NDC"}],"standard_charges":[{"gross_charge":729.31,"discounted_cash":182.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"70655008810","type":"NDC"}],"standard_charges":[{"gross_charge":49.02,"discounted_cash":12.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"70655008806","type":"NDC"}],"standard_charges":[{"gross_charge":50.56,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018487","type":"NDC"}],"standard_charges":[{"gross_charge":32.17,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"409468816","type":"NDC"}],"standard_charges":[{"gross_charge":50.56,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"409468812","type":"NDC"}],"standard_charges":[{"gross_charge":50.56,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole/NS 800 mg piggyback 200 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"36000000310","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole/NS 800 mg piggyback 200 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"36000000306","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole/NS 800 mg piggyback 200 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021011387","type":"NDC"}],"standard_charges":[{"gross_charge":30.64,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"338604537","type":"NDC"}],"standard_charges":[{"gross_charge":58.22,"discounted_cash":14.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"70655000210","type":"NDC"}],"standard_charges":[{"gross_charge":39.83,"discounted_cash":9.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"70655000206","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluconazole in NaCl (iso-osm) per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"409468822","type":"NDC"}],"standard_charges":[{"gross_charge":51.32,"discounted_cash":12.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904728961","type":"NDC"}],"standard_charges":[{"gross_charge":2.79,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679061","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687036811","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estrogens (conjugated) 0.625 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46110281","type":"NDC"}],"standard_charges":[{"gross_charge":29.11,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954056610","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806008901","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862033401","type":"NDC"}],"standard_charges":[{"gross_charge":2.61,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268029211","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555088702","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954056510","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268029111","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"estradioL 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"555088602","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benzoyl peroxide 5 % lotion 29.5 mL Tube","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536105775","type":"NDC"}],"standard_charges":[{"gross_charge":8.67,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"opium 10 mg/mL (morphine) tincture 1 mL Syringe","drug_information":{"unit":0.00508,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710205501","type":"NDC"}],"standard_charges":[{"gross_charge":6.08,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"opium 10 mg/mL (morphine) tincture 118 mL Bottle","drug_information":{"unit":0.00508,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62559015304","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalapril 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672403801","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalapril 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155070501","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enalapril 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679092402","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"conjugated estrogens 0.625 mg/gram cream 30 g TUBE/KIT","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"46087221","type":"NDC"}],"standard_charges":[{"gross_charge":1832.04,"discounted_cash":458.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084038101","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084038111","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 0.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687035611","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687036801","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315013701","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 1 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385010401","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 1 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084038811","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 1 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084038801","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethambutoL 400 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54879000200","type":"NDC"}],"standard_charges":[{"gross_charge":4.03,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethambutoL 400 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084028011","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ganciclovir per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"63323031594","type":"NDC"}],"standard_charges":[{"gross_charge":509.19,"discounted_cash":127.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethambutoL 400 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084028001","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethambutoL 400 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68850001202","type":"NDC"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethambutoL 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54879000100","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethambutoL 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180028001","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethacrynic acid 25 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180015901","type":"NDC"}],"standard_charges":[{"gross_charge":14.14,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethacrynic acid 25 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25010021515","type":"NDC"}],"standard_charges":[{"gross_charge":174.5,"discounted_cash":43.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904728861","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"benztropine 0.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904678861","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ethambutoL 400 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180028101","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ifosfamide per 1 g","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9208","type":"HCPCS"},{"code":"10019092582","type":"NDC"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":68.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ganciclovir per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"70436008955","type":"NDC"}],"standard_charges":[{"gross_charge":157.76,"discounted_cash":39.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"338050348","type":"NDC"}],"standard_charges":[{"gross_charge":20.68,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"641040012","type":"NDC"}],"standard_charges":[{"gross_charge":20.87,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054031","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"81952011210","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"81952011205","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054036","type":"NDC"}],"standard_charges":[{"gross_charge":38.38,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054033","type":"NDC"}],"standard_charges":[{"gross_charge":38.38,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288041996","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288041995","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042196","type":"NDC"}],"standard_charges":[{"gross_charge":29.87,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042195","type":"NDC"}],"standard_charges":[{"gross_charge":29.87,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042096","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042095","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"641040037","type":"NDC"}],"standard_charges":[{"gross_charge":20.87,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054015","type":"NDC"}],"standard_charges":[{"gross_charge":14.32,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739095325","type":"NDC"}],"standard_charges":[{"gross_charge":18.74,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"781354525","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"781354510","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323026211","type":"NDC"}],"standard_charges":[{"gross_charge":6.71,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323026206","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323026203","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739095311","type":"NDC"}],"standard_charges":[{"gross_charge":18.74,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054005","type":"NDC"}],"standard_charges":[{"gross_charge":14.32,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040231","type":"NDC"}],"standard_charges":[{"gross_charge":44.35,"discounted_cash":11.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040230","type":"NDC"}],"standard_charges":[{"gross_charge":44.35,"discounted_cash":11.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739093128","type":"NDC"}],"standard_charges":[{"gross_charge":28.95,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63739093114","type":"NDC"}],"standard_charges":[{"gross_charge":28.95,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040067","type":"NDC"}],"standard_charges":[{"gross_charge":15.7,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1643","type":"HCPCS"},{"code":"69005802","type":"NDC"}],"standard_charges":[{"gross_charge":22.6,"discounted_cash":5.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040030","type":"NDC"}],"standard_charges":[{"gross_charge":31.02,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1643","type":"HCPCS"},{"code":"409272001","type":"NDC"}],"standard_charges":[{"gross_charge":7.91,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol decanoate per 50 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"63323046901","type":"NDC"}],"standard_charges":[{"gross_charge":131.18,"discounted_cash":32.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol decanoate per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"71288050202","type":"NDC"}],"standard_charges":[{"gross_charge":71.15,"discounted_cash":17.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol decanoate per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"71288050201","type":"NDC"}],"standard_charges":[{"gross_charge":71.15,"discounted_cash":17.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol decanoate per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"67457041013","type":"NDC"}],"standard_charges":[{"gross_charge":56.54,"discounted_cash":14.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol decanoate per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"67457041000","type":"NDC"}],"standard_charges":[{"gross_charge":56.54,"discounted_cash":14.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haloperidol decanoate per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"10147092103","type":"NDC"}],"standard_charges":[{"gross_charge":184.43,"discounted_cash":46.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040066","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"409272030","type":"NDC"}],"standard_charges":[{"gross_charge":7.91,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"409272032","type":"NDC"}],"standard_charges":[{"gross_charge":55.84,"discounted_cash":13.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040211","type":"NDC"}],"standard_charges":[{"gross_charge":30.03,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040210","type":"NDC"}],"standard_charges":[{"gross_charge":30.03,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040202","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040201","type":"NDC"}],"standard_charges":[{"gross_charge":12.17,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457095310","type":"NDC"}],"standard_charges":[{"gross_charge":14.09,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457095300","type":"NDC"}],"standard_charges":[{"gross_charge":14.09,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457095630","type":"NDC"}],"standard_charges":[{"gross_charge":26.66,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ganciclovir per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"63323031501","type":"NDC"}],"standard_charges":[{"gross_charge":909.01,"discounted_cash":227.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457095600","type":"NDC"}],"standard_charges":[{"gross_charge":26.66,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457094800","type":"NDC"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457037299","type":"NDC"}],"standard_charges":[{"gross_charge":20.01,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457037212","type":"NDC"}],"standard_charges":[{"gross_charge":20.01,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457038599","type":"NDC"}],"standard_charges":[{"gross_charge":30.03,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457038510","type":"NDC"}],"standard_charges":[{"gross_charge":30.03,"discounted_cash":7.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457038499","type":"NDC"}],"standard_charges":[{"gross_charge":25.51,"discounted_cash":6.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457038431","type":"NDC"}],"standard_charges":[{"gross_charge":25.51,"discounted_cash":6.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457094801","type":"NDC"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"703853023","type":"NDC"}],"standard_charges":[{"gross_charge":67.32,"discounted_cash":16.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bromocriptine 2.5 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574010601","type":"NDC"}],"standard_charges":[{"gross_charge":8.74,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alvimopan 12 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591231245","type":"NDC"}],"standard_charges":[{"gross_charge":579.33,"discounted_cash":144.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 30 mL DROP BTL","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904589430","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 80 MG tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24385011878","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 80 MG tablet,chewable 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333081225","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 80 MG tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000043401","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 80 MG tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896079101","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 80 MG tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904506860","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 80 MG tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37864086001","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 80 MG tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645086001","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 80 MG tablet,chewable 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87701070344","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 80 MG tablet,chewable 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739022510","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"silver sulfADIAZINE 1 % cream 50 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"61570013155","type":"NDC"}],"standard_charges":[{"gross_charge":45.57,"discounted_cash":11.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"silver sulfADIAZINE 1 % cream 50 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"67877012405","type":"NDC"}],"standard_charges":[{"gross_charge":17.01,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"silver sulfADIAZINE 1 % cream 50 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"67877012450","type":"NDC"}],"standard_charges":[{"gross_charge":17.01,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"silver sulfADIAZINE 1 % cream 400 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"67877012440","type":"NDC"}],"standard_charges":[{"gross_charge":122.64,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93075201","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 30 mL DROP BTL","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536222075","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079068401","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 30 mL DROP BTL","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000042301","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 15 mL DROP BTL","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"19903001021","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 650 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333082725","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 650 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333082710","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 650 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904726161","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 650 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333083125","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 650 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333083110","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 650 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"223172101","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium bicarbonate 650 MG tablet 500 each DOSE-PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66553000801","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simple syrup syrup 500 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"38779177908","type":"NDC"}],"standard_charges":[{"gross_charge":99.58,"discounted_cash":24.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simple syrup syrup 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"31722093747","type":"NDC"}],"standard_charges":[{"gross_charge":105.07,"discounted_cash":26.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simple syrup syrup 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"395266116","type":"NDC"}],"standard_charges":[{"gross_charge":119.56,"discounted_cash":29.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 30 mL DROP BTL","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536130375","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 30 mL DROP BTL","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000005101","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 15 mL DROP BTL","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62372063015","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 30 mL DROP BTL","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"56184012041","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 15 mL DROP BTL","drug_information":{"unit":0.02,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"19903001023","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"simethicone 40 mg/0.6 mL drops,suspension 30 mL DROP BTL","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"19903001020","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"487930133","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079075901","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687060511","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lubiprostone 24 MCG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764024060","type":"NDC"}],"standard_charges":[{"gross_charge":25.21,"discounted_cash":6.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ranolazine 500 MG tablet extended release 12 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722066860","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ranolazine 500 MG tablet extended release 12 hr 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687054921","type":"NDC"}],"standard_charges":[{"gross_charge":9.87,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ranolazine 500 MG tablet extended release 12 hr 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687054911","type":"NDC"}],"standard_charges":[{"gross_charge":9.87,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ranolazine 500 MG tablet extended release 12 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756070360","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ranolazine 500 MG tablet extended release 12 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304001760","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ranolazine 500 MG tablet extended release 12 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45963041806","type":"NDC"}],"standard_charges":[{"gross_charge":15.34,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ranolazine 500 MG tablet extended release 12 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180035407","type":"NDC"}],"standard_charges":[{"gross_charge":37.4,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ranolazine 500 MG tablet extended release 12 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958100301","type":"NDC"}],"standard_charges":[{"gross_charge":48.86,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904663961","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084053111","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfacetamide-prednisolone 10 %-0.23 % (0.25 %) drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208031705","type":"NDC"}],"standard_charges":[{"gross_charge":65.73,"discounted_cash":16.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 2 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877043003","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433011501","type":"NDC"}],"standard_charges":[{"gross_charge":14.21,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 2 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162089603","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lubiprostone 24 MCG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"254302902","type":"NDC"}],"standard_charges":[{"gross_charge":4.29,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904718761","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lubiprostone 24 MCG capsule 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"480413806","type":"NDC"}],"standard_charges":[{"gross_charge":7.96,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 50 mcg/actuation spray,suspension 9.9 mL AER W/ADAP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"53100020010","type":"NDC"}],"standard_charges":[{"gross_charge":50.6,"discounted_cash":12.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382002201","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93078701","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93075301","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079068501","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862017001","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atenoloL 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382002401","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cetirizine 1 mg/mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710223505","type":"NDC"}],"standard_charges":[{"gross_charge":0.8,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cetirizine 1 mg/mL solution 5 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710223105","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cetirizine 1 mg/mL solution 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70752010406","type":"NDC"}],"standard_charges":[{"gross_charge":17.35,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cetirizine 1 mg/mL solution 118 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"96295013077","type":"NDC"}],"standard_charges":[{"gross_charge":18.83,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"selegiline 6 mg/24 hr patch 24 hour 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49502090030","type":"NDC"}],"standard_charges":[{"gross_charge":298.44,"discounted_cash":74.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 50 mcg/actuation spray,suspension 11.1 mL AER W/ADAP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536118313","type":"NDC"}],"standard_charges":[{"gross_charge":64.62,"discounted_cash":16.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 50 mcg/actuation spray,suspension 15.8 mL AER W/ADAP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536118365","type":"NDC"}],"standard_charges":[{"gross_charge":50.23,"discounted_cash":12.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 50 mcg/actuation spray,suspension 9.9 mL AER W/ADAP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536118399","type":"NDC"}],"standard_charges":[{"gross_charge":43.37,"discounted_cash":10.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 50 mcg/actuation spray,suspension 15.8 mL AER W/ADAP","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"96295012745","type":"NDC"}],"standard_charges":[{"gross_charge":51.83,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fluticasone propionate 50 mcg/actuation spray,suspension 16 g AER W/ADAP","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"378698501","type":"NDC"}],"standard_charges":[{"gross_charge":2.57,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution for nebulization 15 mL Vial","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"378698789","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204030003","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamoxifen 10 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378014491","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamoxifen 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739026910","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycerin (child) suppository 12 each Jar","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58980040912","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glycerin (child) suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"132008112","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methyl salicylate-menthol 15-10 % cream 85 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802017453","type":"NDC"}],"standard_charges":[{"gross_charge":13.21,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methyl salicylate-menthol 15-10 % cream 85 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"41167060006","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methyl salicylate-menthol 15-10 % cream 85 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536134957","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methyl salicylate-menthol 15-10 % cream 85 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"57896011603","type":"NDC"}],"standard_charges":[{"gross_charge":14.28,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methyl salicylate-menthol 15-10 % cream 85 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"41167060002","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methyl salicylate-menthol 15-10 % cream 85 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"41167006003","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"efavirenz-emtricitabin-tenofov 600-200-300 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"15584010101","type":"NDC"}],"standard_charges":[{"gross_charge":711.51,"discounted_cash":177.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulindac 150 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489047801","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulindac 150 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591566101","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulindac 150 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806001801","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulindac 150 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378042701","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamoxifen 10 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591247260","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfaSALAzine 500 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762500005","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamoxifen 10 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862064260","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamoxifen 10 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907005860","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 15 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079041801","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 15 mg capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268077915","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 15 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268077911","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 15 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739087710","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 15 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877014601","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 15 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228207610","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"72485011010","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"51754050103","type":"NDC"}],"standard_charges":[{"gross_charge":55.41,"discounted_cash":13.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"25021060203","type":"NDC"}],"standard_charges":[{"gross_charge":25.84,"discounted_cash":6.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"47335029044","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrate per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"63323040603","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"peg3350-sod sul-NaCl-KCl-asb-C 100-7.5-2.691 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93356026","type":"NDC"}],"standard_charges":[{"gross_charge":324.32,"discounted_cash":81.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"peg3350-sod sul-NaCl-KCl-asb-C 100-7.5-2.691 gram powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649020175","type":"NDC"}],"standard_charges":[{"gross_charge":500.39,"discounted_cash":125.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"posaconazole 200 mg/5 mL (40 mg/mL) suspension 5 mL Syringe","drug_information":{"unit":0.02381,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710206005","type":"NDC"}],"standard_charges":[{"gross_charge":133.98,"discounted_cash":33.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"posaconazole 200 mg/5 mL (40 mg/mL) suspension 105 mL Bottle","drug_information":{"unit":0.02381,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"85132801","type":"NDC"}],"standard_charges":[{"gross_charge":134.16,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tamoxifen 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739014310","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfaSALAzine 500 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13010110","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfaSALAzine 500 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591079601","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 400-80 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687060365","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine 1 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65081702","type":"NDC"}],"standard_charges":[{"gross_charge":164.89,"discounted_cash":41.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine 1 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60219174802","type":"NDC"}],"standard_charges":[{"gross_charge":144.73,"discounted_cash":36.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine 1 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60505622600","type":"NDC"}],"standard_charges":[{"gross_charge":152.8,"discounted_cash":38.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine 1 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"65030355","type":"NDC"}],"standard_charges":[{"gross_charge":194.63,"discounted_cash":48.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine 1 % drops 5 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478021505","type":"NDC"}],"standard_charges":[{"gross_charge":146.58,"discounted_cash":36.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine 1 % drops 2 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478021502","type":"NDC"}],"standard_charges":[{"gross_charge":117.26,"discounted_cash":29.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfacetamide 10 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314070101","type":"NDC"}],"standard_charges":[{"gross_charge":137.97,"discounted_cash":34.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfacetamide 10 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208067004","type":"NDC"}],"standard_charges":[{"gross_charge":170.67,"discounted_cash":42.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atropine 1 % ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24208082555","type":"NDC"}],"standard_charges":[{"gross_charge":75.01,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3 % solution for nebulization 15 mL Vial","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710801306","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3 % solution for nebulization 4 mL Vial","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204002260","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3 % solution for nebulization 4 mL Vial","drug_information":{"unit":0.75,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50190014263","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 3 % solution for nebulization 15 mL Vial","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"378699789","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution for nebulization 3 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70756066199","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % solution for nebulization 15 mL Vial","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"76204030050","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sorbitoL 70 % solution 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"46287050001","type":"NDC"}],"standard_charges":[{"gross_charge":83.33,"discounted_cash":20.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sorbitoL 70 % solution 30 mL BLIST PACK","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"46287050030","type":"NDC"}],"standard_charges":[{"gross_charge":21.14,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904595161","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739054410","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 400-80 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687060311","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 400-80 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162027110","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 400-80 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268072815","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 400-80 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268072811","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 400-80 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746027101","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 800-160 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489014601","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 800-160 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237023301","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 2 MG tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268008712","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sulfamethoxazole-trimethoprim 800-160 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904272561","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone-hydroCHLOROthiazide 25-25 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378040301","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079010301","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904692761","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687046511","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone 25 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687046501","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382066001","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone 25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746051101","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"spironolactone-hydroCHLOROthiazide 25-25 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489014401","type":"NDC"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268008711","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 2 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862066130","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 2 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505307503","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid 1000 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268086215","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid 1000 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268086211","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746011306","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079054101","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904738106","type":"NDC"}],"standard_charges":[{"gross_charge":5.24,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268068415","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268068411","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746011506","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079054201","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241028701","type":"NDC"}],"standard_charges":[{"gross_charge":2.69,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687082511","type":"NDC"}],"standard_charges":[{"gross_charge":6.11,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687082565","type":"NDC"}],"standard_charges":[{"gross_charge":6.11,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904738206","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268068515","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"prochlorperazine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268068511","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid 1000 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681016600","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"primidone 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746054501","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine-codeine 6.25-10 mg/5 mL syrup 5 mL Syringe","drug_information":{"unit":0.04237,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710020650","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine-codeine 6.25-10 mg/5 mL syrup 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213705","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"proparacaine 0.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478026312","type":"NDC"}],"standard_charges":[{"gross_charge":134.51,"discounted_cash":33.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"proparacaine 0.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70069060101","type":"NDC"}],"standard_charges":[{"gross_charge":57.14,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid (vitamin C) 500 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094011359","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid (vitamin C) 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094011361","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid (vitamin C) 500 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904052361","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid (vitamin C) 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904052360","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid (vitamin C) 500 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645092001","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555000100","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268086015","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268086011","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ascorbic acid 250 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904052260","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine-codeine 6.25-10 mg/5 mL syrup 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"60432060616","type":"NDC"}],"standard_charges":[{"gross_charge":192.7,"discounted_cash":48.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine-codeine 6.25-10 mg/5 mL syrup 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383080416","type":"NDC"}],"standard_charges":[{"gross_charge":35.76,"discounted_cash":8.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine-codeine 6.25-10 mg/5 mL syrup 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213505","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine-codeine 6.25-10 mg/5 mL syrup 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710214605","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"promethazine-codeine 6.25-10 mg/5 mL syrup 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"27808006502","type":"NDC"}],"standard_charges":[{"gross_charge":107.28,"discounted_cash":26.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"primidone 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268068711","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"primidone 250 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268068715","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"primidone 250 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084020311","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"54874025","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"603533621","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"904692361","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"70954005910","type":"NDC"}],"standard_charges":[{"gross_charge":1.31,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687013411","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687013401","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"63739051910","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746017306","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"54001720","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"54873925","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"64380078206","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746017106","type":"NDC"}],"standard_charges":[{"gross_charge":1.99,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"603533521","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"54372250","type":"NDC"}],"standard_charges":[{"gross_charge":293.83,"discounted_cash":73.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":0.04167,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"97710206105","type":"NDC"}],"standard_charges":[{"gross_charge":11.51,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"54001820","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"54001829","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"54001825","type":"NDC"}],"standard_charges":[{"gross_charge":2.09,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746017506","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"primidone 250 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084020301","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"54872425","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"70954005810","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687012211","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687012201","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"63739051810","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687092511","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"proparacaine 0.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208073006","type":"NDC"}],"standard_charges":[{"gross_charge":140.05,"discounted_cash":35.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687092501","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"904712761","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"70954006010","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687014511","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687014501","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"63739058810","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"591544310","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746017509","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"predniSONE per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59651048801","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 30 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228207710","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"proparacaine 0.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"gross_charge":137.03,"discounted_cash":34.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591555401","type":"NDC"}],"standard_charges":[{"gross_charge":2.63,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 300 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739043402","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 1,000 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679480","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679489","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 750 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739043401","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridoxine (vitamin B6) 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10006073017","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridoxine (vitamin B6) 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333094025","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridoxine (vitamin B6) 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333094010","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridoxine (vitamin B6) 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268085811","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridoxine (vitamin B6) 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37864090901","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridoxine (vitamin B6) 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536440801","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyridoxine (vitamin B6) 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51645090901","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyrazinamide 500 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748001211","type":"NDC"}],"standard_charges":[{"gross_charge":8.62,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyrazinamide 500 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748001201","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyrazinamide 500 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687078911","type":"NDC"}],"standard_charges":[{"gross_charge":26.55,"discounted_cash":6.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyrazinamide 500 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687078901","type":"NDC"}],"standard_charges":[{"gross_charge":26.55,"discounted_cash":6.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 300 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904679430","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pyrazinamide 500 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954048410","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 150 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333004920","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 300 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904750930","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole 2 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59148000613","type":"NDC"}],"standard_charges":[{"gross_charge":78.36,"discounted_cash":19.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium, sodium phosphates 280-160-250 mg powder in packet 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60258000601","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium, sodium phosphates 280-160-250 mg powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71351001099","type":"NDC"}],"standard_charges":[{"gross_charge":5.01,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium, sodium phosphates 280-160-250 mg powder in packet 100 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71351001001","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium, sodium phosphates 280-160-250 mg powder in packet 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60258000615","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 300 MG suppository 12 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"574703412","type":"NDC"}],"standard_charges":[{"gross_charge":6.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896092101","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536123201","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet,delayed release (DR/EC) 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904201360","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet 500 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66553000101","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"96295013147","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000025302","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536105429","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 500 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66553000201","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 36 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896091136","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,chewable 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333004925","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pseudoephedrine 30 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904699061","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pseudoephedrine 30 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904505359","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propylthiouracil 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"480924201","type":"NDC"}],"standard_charges":[{"gross_charge":3.2,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69292053201","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904670561","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115166001","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591555501","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603548321","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111046701","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268066215","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268066211","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238207701","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687058711","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687058701","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115165901","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"},{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904655061","type":"NDC"}],"standard_charges":[{"gross_charge":1.73,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904041161","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904670506","type":"NDC"}],"standard_charges":[{"gross_charge":2.51,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059801","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687059811","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238207801","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propylthiouracil 50 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084096495","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propylthiouracil 50 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084096425","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propylthiouracil 50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"228234810","type":"NDC"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079027901","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268066415","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268066411","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687060911","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 mg/5 mL (4 mg/mL) solution 500 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"54372763","type":"NDC"}],"standard_charges":[{"gross_charge":197.4,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687060901","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268070215","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268070211","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"115166101","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591555601","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378018401","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268066315","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 20 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268066311","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propranoloL 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238207901","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 30 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268078011","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 30 mg capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268078013","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"temazepam 30 mg capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079041901","type":"NDC"}],"standard_charges":[{"gross_charge":1.47,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155022901","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268006011","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 MG capsule 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268006015","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904578961","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 5 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"65162083594","type":"NDC"}],"standard_charges":[{"gross_charge":1064.64,"discounted_cash":266.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 5 % ointment 5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51079055067","type":"NDC"}],"standard_charges":[{"gross_charge":439.74,"discounted_cash":109.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 5 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"378870006","type":"NDC"}],"standard_charges":[{"gross_charge":293.52,"discounted_cash":73.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 500 mg capsule, extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268004211","type":"NDC"}],"standard_charges":[{"gross_charge":17.16,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 500 mg capsule, extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729033101","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 500 mg capsule, extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571024301","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 500 mg capsule, extended release 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057821","type":"NDC"}],"standard_charges":[{"gross_charge":19.64,"discounted_cash":4.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 500 mg capsule, extended release 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687057811","type":"NDC"}],"standard_charges":[{"gross_charge":19.64,"discounted_cash":4.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE 500 mg capsule, extended release 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742023301","type":"NDC"}],"standard_charges":[{"gross_charge":4.38,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"butalbital-acetaminophen-caff 50-325-40 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268055313","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"butalbital-acetaminophen-caff 50-325-40 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268055311","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72578000201","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"butalbital-acetaminophen-caff 50-325-40 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687067211","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 MG capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904751961","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"472008216","type":"NDC"}],"standard_charges":[{"gross_charge":1122.43,"discounted_cash":280.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 800 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268006211","type":"NDC"}],"standard_charges":[{"gross_charge":3.37,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 800 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084010911","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 800 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084010901","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 800 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722077801","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710222305","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"72205017072","type":"NDC"}],"standard_charges":[{"gross_charge":331.76,"discounted_cash":82.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"23155048551","type":"NDC"}],"standard_charges":[{"gross_charge":639.69,"discounted_cash":159.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216405","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70954018810","type":"NDC"}],"standard_charges":[{"gross_charge":516.52,"discounted_cash":129.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710204005","type":"NDC"}],"standard_charges":[{"gross_charge":21.46,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"378871273","type":"NDC"}],"standard_charges":[{"gross_charge":2030.31,"discounted_cash":507.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710213305","type":"NDC"}],"standard_charges":[{"gross_charge":9.39,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710207605","type":"NDC"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"40085084296","type":"NDC"}],"standard_charges":[{"gross_charge":888.01,"discounted_cash":222.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 5 mL Syringe","drug_information":{"unit":0.01057,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710203805","type":"NDC"}],"standard_charges":[{"gross_charge":9.68,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 200 mg/5 mL suspension 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383081016","type":"NDC"}],"standard_charges":[{"gross_charge":915.82,"discounted_cash":228.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"butalbital-acetaminophen-caff 50-325-40 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010014901","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"butalbital-acetaminophen-caff 50-325-40 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904693806","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"butalbital-acetaminophen-caff 50-325-40 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"527169501","type":"NDC"}],"standard_charges":[{"gross_charge":2.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc sulfate 50 mg zinc (220 mg) capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333098310","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc sulfate 50 mg zinc (220 mg) capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"731040106","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc oxide 20 % ointment 30 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536131628","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc oxide 20 % ointment 28.4 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"75834017001","type":"NDC"}],"standard_charges":[{"gross_charge":28.03,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 30 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219126401","type":"NDC"}],"standard_charges":[{"gross_charge":74.33,"discounted_cash":18.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 30 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205004211","type":"NDC"}],"standard_charges":[{"gross_charge":5.71,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 30 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380079701","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 30 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722063031","type":"NDC"}],"standard_charges":[{"gross_charge":6.88,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 30 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180067511","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 30 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710100802","type":"NDC"}],"standard_charges":[{"gross_charge":25.38,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 30 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781046813","type":"NDC"}],"standard_charges":[{"gross_charge":72.41,"discounted_cash":18.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oseltamivir 30 MG capsule 10 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"4080285","type":"NDC"}],"standard_charges":[{"gross_charge":101.03,"discounted_cash":25.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"raltegravir 400 mg tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6022761","type":"NDC"}],"standard_charges":[{"gross_charge":259.31,"discounted_cash":64.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 5-7.5-10 mg kit 1 each KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682065220","type":"NDC"}],"standard_charges":[{"gross_charge":1052.9,"discounted_cash":263.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazePAM 5-7.5-10 mg kit 1 each KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"187065820","type":"NDC"}],"standard_charges":[{"gross_charge":1371.05,"discounted_cash":342.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc sulfate 50 mg zinc (220 mg) capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333098325","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc sulfate 50 mg zinc (220 mg) capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555004000","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zinc sulfate 50 mg zinc (220 mg) capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68585000801","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nebivoloL 2.5 MG tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"456140230","type":"NDC"}],"standard_charges":[{"gross_charge":46.37,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"butalbital-acetaminophen-caff 50-325-40 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084039611","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"butalbital-acetaminophen-caff 50-325-40 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603254421","type":"NDC"}],"standard_charges":[{"gross_charge":7.54,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-60 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93035001","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-60 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380044701","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-60 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687061511","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-60 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71930005612","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-60 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084037311","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acyclovir 800 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268006215","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-60 mg tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406048505","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 300 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739017830","type":"NDC"}],"standard_charges":[{"gross_charge":43.12,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 300 mg tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904646710","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 300 mg tablet 20 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268018412","type":"NDC"}],"standard_charges":[{"gross_charge":27.4,"discounted_cash":6.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 300 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268018411","type":"NDC"}],"standard_charges":[{"gross_charge":27.4,"discounted_cash":6.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 300 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904646707","type":"NDC"}],"standard_charges":[{"gross_charge":49.9,"discounted_cash":12.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 300 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084075295","type":"NDC"}],"standard_charges":[{"gross_charge":48.76,"discounted_cash":12.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"clopidogreL 300 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111067106","type":"NDC"}],"standard_charges":[{"gross_charge":75.2,"discounted_cash":18.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen-codeine 300-60 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"406048501","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 7.5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93172301","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"albendazole 200 mg tablet 2 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52054055022","type":"NDC"}],"standard_charges":[{"gross_charge":946.92,"discounted_cash":236.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL (25 %) solution 236.5 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"49411005208","type":"NDC"}],"standard_charges":[{"gross_charge":10925.31,"discounted_cash":2731.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000017803","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"536123441","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"96295013586","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000042801","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"96295013056","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000020301","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896098112","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483048112","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904770418","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"280210012","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739052210","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 750 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739052201","type":"NDC"}],"standard_charges":[{"gross_charge":1.19,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 200 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12843053640","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"603002622","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 5 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180072009","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000021802","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 5 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097012705","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739021210","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 300 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739021202","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"alvimopan 12 mg capsule 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591231215","type":"NDC"}],"standard_charges":[{"gross_charge":579.33,"discounted_cash":144.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaTHIOprine per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"51079062001","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaTHIOprine per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"68084022911","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"azaTHIOprine per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7500","type":"HCPCS"},{"code":"68084022901","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 5 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555003901","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 5 mg tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555003900","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 5 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333052025","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 5 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333052010","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"melatonin 5 mg tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31604002743","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet 130 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"96295012961","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet 130 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000014701","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 325 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904201559","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 32 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12843006132","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 150 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333003120","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333003125","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aspirin 81 MG tablet,delayed release (DR/EC) 120 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618006602","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268008411","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 5 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268008415","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904637061","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382022714","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"245014789","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739038710","type":"NDC"}],"standard_charges":[{"gross_charge":2.03,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 500 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238163703","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 500 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050595","type":"NDC"}],"standard_charges":[{"gross_charge":94.4,"discounted_cash":23.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 500 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050525","type":"NDC"}],"standard_charges":[{"gross_charge":94.4,"discounted_cash":23.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 500 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219163703","type":"NDC"}],"standard_charges":[{"gross_charge":43.99,"discounted_cash":11.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 500 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49411005030","type":"NDC"}],"standard_charges":[{"gross_charge":84.96,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 500 mg tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61748004511","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL (25 %) solution 237 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61748004408","type":"NDC"}],"standard_charges":[{"gross_charge":2332.22,"discounted_cash":583.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL (25 %) solution 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220406","type":"NDC"}],"standard_charges":[{"gross_charge":88.49,"discounted_cash":22.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL (25 %) solution 236.5 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70377010411","type":"NDC"}],"standard_charges":[{"gross_charge":6659.08,"discounted_cash":1664.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL (25 %) solution 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710216906","type":"NDC"}],"standard_charges":[{"gross_charge":287.45,"discounted_cash":71.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL (25 %) solution 236.5 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689033008","type":"NDC"}],"standard_charges":[{"gross_charge":2771.31,"discounted_cash":692.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL (25 %) solution 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710209906","type":"NDC"}],"standard_charges":[{"gross_charge":461.96,"discounted_cash":115.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084037111","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862073260","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043701","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687043711","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079045101","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687028511","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687028501","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 2.5 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097012605","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904636961","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049611","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687049601","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminocaproic acid 250 mg/mL (25 %) solution 10 mL Syringe","drug_information":{"unit":0.04219,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710200606","type":"NDC"}],"standard_charges":[{"gross_charge":99.67,"discounted_cash":24.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 10 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097012805","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904637161","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 10 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806005709","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079045201","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672402504","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888003960","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904699361","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone 200 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739005110","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amLODIPine 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739063110","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bromocriptine 2.5 mg tablet 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"781532531","type":"NDC"}],"standard_charges":[{"gross_charge":21.01,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 7.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56017301","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121689","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.1 % ointment 454 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802005505","type":"NDC"}],"standard_charges":[{"gross_charge":133.48,"discounted_cash":33.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.1 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168000615","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.1 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"gross_charge":12.66,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.1 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"67877025115","type":"NDC"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.1 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"168000415","type":"NDC"}],"standard_charges":[{"gross_charge":10.71,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111043301","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111056001","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904686861","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 50 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687044311","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 50 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687044301","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505265301","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111043401","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 100 MG tablet 500 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111056102","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 100 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111056101","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904686961","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.1 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672128401","type":"NDC"}],"standard_charges":[{"gross_charge":16.76,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687045411","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.1 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"33342033315","type":"NDC"}],"standard_charges":[{"gross_charge":8.19,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.5 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"68462079817","type":"NDC"}],"standard_charges":[{"gross_charge":32.63,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triazolam 0.25 MG tablet 10 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762371804","type":"NDC"}],"standard_charges":[{"gross_charge":6.74,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triazolam 0.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710128901","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triazolam 0.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54485925","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triazolam 0.25 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762371809","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triazolam 0.125 MG tablet 10 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762371704","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":1.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triazolam 0.125 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710152101","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triazolam 0.125 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54485825","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triazolam 0.125 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762371709","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamterene-hydroCHLOROthiazide 75-50 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079043301","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamterene-hydroCHLOROthiazide 75-50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888009501","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamterene-hydroCHLOROthiazide 75-50 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505265701","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamterene-hydroCHLOROthiazide 37.5-25 mg tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084075095","type":"NDC"}],"standard_charges":[{"gross_charge":4.33,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamterene-hydroCHLOROthiazide 37.5-25 mg tablet 30 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084075025","type":"NDC"}],"standard_charges":[{"gross_charge":4.33,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamterene-hydroCHLOROthiazide 37.5-25 mg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505265601","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.5 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802004935","type":"NDC"}],"standard_charges":[{"gross_charge":17.64,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone 0.1 % ointment 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":17.96,"discounted_cash":4.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"traZODone 100 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687045401","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolnaftate 1 % powder 45 g Bottle","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536132926","type":"NDC"}],"standard_charges":[{"gross_charge":9.26,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolnaftate 1 % powder 45 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904072645","type":"NDC"}],"standard_charges":[{"gross_charge":10.21,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 5 mg/5 mL solution 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689003150","type":"NDC"}],"standard_charges":[{"gross_charge":14.41,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 5 mg/5 mL solution 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689003101","type":"NDC"}],"standard_charges":[{"gross_charge":14.41,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"metoclopramide 5 mg/5 mL solution 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121157610","type":"NDC"}],"standard_charges":[{"gross_charge":14.28,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atazanavir 300 MG capsule 30 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"3362212","type":"NDC"}],"standard_charges":[{"gross_charge":360.83,"discounted_cash":90.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SITagliptin phosphate 50 MG tablet 90 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6011254","type":"NDC"}],"standard_charges":[{"gross_charge":79.75,"discounted_cash":19.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42571046475","type":"NDC"}],"standard_charges":[{"gross_charge":9.11,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"42571046473","type":"NDC"}],"standard_charges":[{"gross_charge":9.11,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70748017501","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62756027702","type":"NDC"}],"standard_charges":[{"gross_charge":8.54,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"62756027701","type":"NDC"}],"standard_charges":[{"gross_charge":8.54,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70748017530","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70748025730","type":"NDC"}],"standard_charges":[{"gross_charge":20.85,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70748025701","type":"NDC"}],"standard_charges":[{"gross_charge":20.85,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63402091101","type":"NDC"}],"standard_charges":[{"gross_charge":73.24,"discounted_cash":18.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arformoteroL 15 mcg/2 mL solution for nebulization 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"63402091130","type":"NDC"}],"standard_charges":[{"gross_charge":73.24,"discounted_cash":18.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetrahydrozoline 0.05 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536100294","type":"NDC"}],"standard_charges":[{"gross_charge":6.87,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetrahydrozoline 0.05 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"904633435","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetrahydrozoline 0.05 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"536121794","type":"NDC"}],"standard_charges":[{"gross_charge":6.99,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetrahydrozoline 0.05 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70000045401","type":"NDC"}],"standard_charges":[{"gross_charge":7.62,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolnaftate 1 % powder 45 g Jar","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536515026","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolnaftate 1 % cream 15 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"51672202001","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolnaftate 1 % cream 14.18 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"536131543","type":"NDC"}],"standard_charges":[{"gross_charge":6.91,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tolnaftate 1 % cream 14.18 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"904072236","type":"NDC"}],"standard_charges":[{"gross_charge":6.07,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thiothixene 10 MG capsule 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079058901","type":"NDC"}],"standard_charges":[{"gross_charge":15.8,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thioridazine 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489015001","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thioridazine 50 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378061601","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoal-sorbitoL 50 gram/240 mL suspension 240 mL Bottle","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"66689020308","type":"NDC"}],"standard_charges":[{"gross_charge":69.05,"discounted_cash":17.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thioridazine 25 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079056601","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thioridazine 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079056501","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin-codeine 10-100 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"97710220006","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin-codeine 10-100 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121155010","type":"NDC"}],"standard_charges":[{"gross_charge":20.58,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin-codeine 10-100 mg/5 mL liquid 473 mL Bottle","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"58657050016","type":"NDC"}],"standard_charges":[{"gross_charge":93.37,"discounted_cash":23.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin-codeine 10-100 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"50383008710","type":"NDC"}],"standard_charges":[{"gross_charge":2.35,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"guaiFENesin-codeine 10-100 mg/5 mL liquid 10 mL Cup","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"121177510","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetrahydrozoline 0.05 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"12547049380","type":"NDC"}],"standard_charges":[{"gross_charge":18.71,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"thioridazine 100 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079058001","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 5 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93172101","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoal-sorbitoL 50 gram/240 mL suspension 240 mL Tube","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574012076","type":"NDC"}],"standard_charges":[{"gross_charge":39.82,"discounted_cash":9.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoal-sorbitoL 50 gram/240 mL suspension 240 mL Bottle","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574052008","type":"NDC"}],"standard_charges":[{"gross_charge":46.87,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vitamin A 10000 UNIT capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904208560","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657093110","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657093105","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657073101","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687081511","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687081501","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050311","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687050301","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 50 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268010615","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268010611","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904647561","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084085511","type":"NDC"}],"standard_charges":[{"gross_charge":2.57,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739047910","type":"NDC"}],"standard_charges":[{"gross_charge":4.62,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"baclofen 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"172409660","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin-polymyxin B 500-10,000 unit/gram ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"gross_charge":88.58,"discounted_cash":22.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vitamin A 10000 UNIT capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"40093010144","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin-polymyxin B 500-10,000 unit/gram ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"17478023835","type":"NDC"}],"standard_charges":[{"gross_charge":52.17,"discounted_cash":13.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione (vitamin K1) 100 mcg tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11845007791","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 10 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121989","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56017201","type":"NDC"}],"standard_charges":[{"gross_charge":10.02,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584099411","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121601","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584099401","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2.5 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121389","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56017601","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084002711","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084002701","type":"NDC"}],"standard_charges":[{"gross_charge":2.05,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2.5 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121301","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121289","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56017001","type":"NDC"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2 MG tablet 1 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584098411","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832121201","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584098401","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 10 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"93172001","type":"NDC"}],"standard_charges":[{"gross_charge":0.7,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"warfarin 10 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56017401","type":"NDC"}],"standard_charges":[{"gross_charge":12.47,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bacitracin-polymyxin B 500-10,000 unit/gram ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574402135","type":"NDC"}],"standard_charges":[{"gross_charge":24.95,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracnZn-polymyxnB 3.5mg-400 unit- 5,000 unit/gram ointment 14 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"61269017934","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracnZn-polymyxnB 3.5mg-400 unit- 5,000 unit/gram ointment 14 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"45802014301","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivastigmine 4.6 mg/24 hour patch 24 hour 1 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78050161","type":"NDC"}],"standard_charges":[{"gross_charge":90.9,"discounted_cash":22.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivastigmine 4.6 mg/24 hour patch 24 hour 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78050115","type":"NDC"}],"standard_charges":[{"gross_charge":90.9,"discounted_cash":22.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tropicamide 1 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314035502","type":"NDC"}],"standard_charges":[{"gross_charge":119.51,"discounted_cash":29.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tropicamide 1 % drops 3 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314035501","type":"NDC"}],"standard_charges":[{"gross_charge":43.47,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tropicamide 1 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208058564","type":"NDC"}],"standard_charges":[{"gross_charge":19.47,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tropicamide 1 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478010212","type":"NDC"}],"standard_charges":[{"gross_charge":27.03,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tropicamide 1 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"70069012101","type":"NDC"}],"standard_charges":[{"gross_charge":44.42,"discounted_cash":11.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tropicamide 0.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"61314035401","type":"NDC"}],"standard_charges":[{"gross_charge":97.59,"discounted_cash":24.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tropicamide 0.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"24208059064","type":"NDC"}],"standard_charges":[{"gross_charge":19.47,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tropicamide 0.5 % drops 15 mL DROP BTL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"17478010112","type":"NDC"}],"standard_charges":[{"gross_charge":20.79,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUEtiapine XR 400 MG tablet extended release 24 hr 60 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"310028460","type":"NDC"}],"standard_charges":[{"gross_charge":180.42,"discounted_cash":45.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trifluoperazine 2 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079057320","type":"NDC"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trifluoperazine 2 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"378240201","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisdexamfetamine 50 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417010510","type":"NDC"}],"standard_charges":[{"gross_charge":51.39,"discounted_cash":12.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lisdexamfetamine 30 MG capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59417010310","type":"NDC"}],"standard_charges":[{"gross_charge":51.39,"discounted_cash":12.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivastigmine 4.6 mg/24 hour patch 24 hour 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781030403","type":"NDC"}],"standard_charges":[{"gross_charge":67.07,"discounted_cash":16.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivastigmine 9.5 mg/24 hour patch 24 hour 30 each Box","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781030503","type":"NDC"}],"standard_charges":[{"gross_charge":12.08,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rivastigmine 9.5 mg/24 hour patch 24 hour 1 each Packet","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781030511","type":"NDC"}],"standard_charges":[{"gross_charge":12.08,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproic acid 250 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739025110","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracnZn-polymyxnB 3.5mg-400 unit- 5,000 unit/gram ointment 14.2 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"810073088","type":"NDC"}],"standard_charges":[{"gross_charge":19.8,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracnZn-polymyxnB 3.5mg-400 unit- 5,000 unit/gram ointment 14 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"472017934","type":"NDC"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 80 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904292061","type":"NDC"}],"standard_charges":[{"gross_charge":1.29,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 80 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155002601","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155005901","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 40 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591040401","type":"NDC"}],"standard_charges":[{"gross_charge":1.58,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 120 MG tablet 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155048601","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"activated charcoal-sorbitoL 50 gram/240 mL suspension 240 mL Tube","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"637","type":"RC"},{"code":"574052076","type":"NDC"}],"standard_charges":[{"gross_charge":42.34,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"verapamiL 120 MG tablet 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"904292461","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracin-polymyxin-hydrocortisone 3.5-400-10,000 mg-unit/g-1% ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"574414435","type":"NDC"}],"standard_charges":[{"gross_charge":23.9,"discounted_cash":5.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracin-polymyxin-hydrocortisone 3.5-400-10,000 mg-unit/g-1% ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"17478071935","type":"NDC"}],"standard_charges":[{"gross_charge":259.01,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproic acid 250 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111085201","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproic acid 250 mg capsule 100 each BLIST PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739008610","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproic acid 250 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452015020","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproic acid 250 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"832031011","type":"NDC"}],"standard_charges":[{"gross_charge":2.71,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"valproic acid 250 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"591401201","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neomycin-bacitracin-polymyxin-hydrocortisone 3.5-400-10,000 mg-unit/g-1% ointment 3.5 g Tube","drug_information":{"unit":1.0,"type":"GM"},"code_information":[{"code":"637","type":"RC"},{"code":"24208078555","type":"NDC"}],"standard_charges":[{"gross_charge":109.79,"discounted_cash":27.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323055921","type":"NDC"}],"standard_charges":[{"gross_charge":42.53,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323053301","type":"NDC"}],"standard_charges":[{"gross_charge":55.78,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323053383","type":"NDC"}],"standard_charges":[{"gross_charge":55.78,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine HCl (PF) per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0165","type":"HCPCS"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"gross_charge":65.26,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine HCl (PF) per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0165","type":"HCPCS"},{"code":"54288010301","type":"NDC"}],"standard_charges":[{"gross_charge":65.26,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323020805","type":"NDC"}],"standard_charges":[{"gross_charge":32.44,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) PF per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323027602","type":"NDC"}],"standard_charges":[{"gross_charge":38.42,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) PF per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"781355525","type":"NDC"}],"standard_charges":[{"gross_charge":18.41,"discounted_cash":4.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) PF per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323027601","type":"NDC"}],"standard_charges":[{"gross_charge":38.42,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) PF per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040003","type":"NDC"}],"standard_charges":[{"gross_charge":64.27,"discounted_cash":16.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) PF per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040002","type":"NDC"}],"standard_charges":[{"gross_charge":64.27,"discounted_cash":16.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) PF per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1643","type":"HCPCS"},{"code":"69004302","type":"NDC"}],"standard_charges":[{"gross_charge":35.04,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEParin (porcine) PF per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040102","type":"NDC"}],"standard_charges":[{"gross_charge":39.14,"discounted_cash":9.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin, porcine (PF) per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253033335","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin, porcine (PF) per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306515","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin, porcine (PF) per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306513","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin, porcine (PF) per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"8290306424","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin, porcine (PF) per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"63807060051","type":"NDC"}],"standard_charges":[{"gross_charge":3.87,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis B immune globulin per 1 mL","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"13533063603","type":"NDC"}],"standard_charges":[{"gross_charge":1145.78,"discounted_cash":286.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in lactated ringers per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"72196603901","type":"NDC"}],"standard_charges":[{"gross_charge":111.07,"discounted_cash":27.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis B immune globulin per 1 mL","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90371","type":"HCPCS"},{"code":"13533063630","type":"NDC"}],"standard_charges":[{"gross_charge":1145.78,"discounted_cash":286.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis B virus vacc.rec(PF) 20 mcg/mL syringe 1 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082152","type":"NDC"}],"standard_charges":[{"gross_charge":172.83,"discounted_cash":43.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone (PF) 2 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"641615125","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone (PF) 2 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"641615101","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone (PF) 2 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323085325","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone (PF) 2 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323085303","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis B virus vaccine PF 20 mcg/mL suspension 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082101","type":"NDC"}],"standard_charges":[{"gross_charge":367.74,"discounted_cash":91.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis B virus vaccine PF 20 mcg/mL suspension 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082111","type":"NDC"}],"standard_charges":[{"gross_charge":367.74,"discounted_cash":91.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis B virus vacc.rec(PF) per 0.5 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90744","type":"HCPCS"},{"code":"58160082001","type":"NDC"}],"standard_charges":[{"gross_charge":82.56,"discounted_cash":20.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Hepatitis B Vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90759","type":"HCPCS"},{"code":"58160082043","type":"NDC"}],"standard_charges":[{"gross_charge":156.19,"discounted_cash":39.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Hepatitis B Vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90759","type":"HCPCS"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"gross_charge":156.19,"discounted_cash":39.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hepatitis B virus vacc.rec(PF) 20 mcg/mL syringe 1 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082143","type":"NDC"}],"standard_charges":[{"gross_charge":172.83,"discounted_cash":43.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in lactated ringers per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"71285603901","type":"NDC"}],"standard_charges":[{"gross_charge":76.6,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in lactated ringers per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"70092107124","type":"NDC"}],"standard_charges":[{"gross_charge":153.2,"discounted_cash":38.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin in 0.9% sod chloride per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"70092101803","type":"NDC"}],"standard_charges":[{"gross_charge":84.26,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gentamicin in NaCl (iso-osm) per 80 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"338050748","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminophylline per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"409592216","type":"NDC"}],"standard_charges":[{"gross_charge":82.42,"discounted_cash":20.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"aminophylline per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"409592201","type":"NDC"}],"standard_charges":[{"gross_charge":82.42,"discounted_cash":20.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"143953410","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"143953401","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"63323071303","type":"NDC"}],"standard_charges":[{"gross_charge":351.59,"discounted_cash":87.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"66794021963","type":"NDC"}],"standard_charges":[{"gross_charge":252.78,"discounted_cash":63.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"66794021943","type":"NDC"}],"standard_charges":[{"gross_charge":252.78,"discounted_cash":63.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"25021016987","type":"NDC"}],"standard_charges":[{"gross_charge":163.16,"discounted_cash":40.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"57664068357","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"57664068331","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"55150024251","type":"NDC"}],"standard_charges":[{"gross_charge":57.45,"discounted_cash":14.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"63323071313","type":"NDC"}],"standard_charges":[{"gross_charge":351.59,"discounted_cash":87.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"9780701","type":"NDC"}],"standard_charges":[{"gross_charge":328.61,"discounted_cash":82.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin in 0.9% sod chloride per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"70092162203","type":"NDC"}],"standard_charges":[{"gross_charge":111.84,"discounted_cash":27.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in lactated ringers per 10 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"97710500904","type":"NDC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in 0.9 % sod chloride 30 unit/500 mL solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"70092106807","type":"NDC"}],"standard_charges":[{"gross_charge":164.69,"discounted_cash":41.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in 0.9 % sod chloride 30 unit/500 mL solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"70092155207","type":"NDC"}],"standard_charges":[{"gross_charge":141.71,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water 5 % piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"338055118","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water 5 % piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"338055111","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dextrose 5 % in water 5 % piggyback 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"409710002","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % piggyback 100 mL Bag","drug_information":{"unit":10.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338966235","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % piggyback 100 mL Bag","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338915930","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % piggyback 100 mL Bag","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338055318","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9 % piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J7050","type":"HCPCS"},{"code":"338055311","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCl per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0592","type":"HCPCS"},{"code":"12496075701","type":"NDC"}],"standard_charges":[{"gross_charge":108.01,"discounted_cash":27.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCl per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0592","type":"HCPCS"},{"code":"42023017901","type":"NDC"}],"standard_charges":[{"gross_charge":95.43,"discounted_cash":23.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"buprenorphine HCl per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0592","type":"HCPCS"},{"code":"12496075705","type":"NDC"}],"standard_charges":[{"gross_charge":108.01,"discounted_cash":27.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetanus-diphtheria-pertussis,acell per 0.5 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160084201","type":"NDC"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":69.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetanus-diphtheria-pertussis,acell per 0.5 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160084211","type":"NDC"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":69.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in 0.9 % sod chloride 30 unit/500 mL solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"71266510301","type":"NDC"}],"standard_charges":[{"gross_charge":88.09,"discounted_cash":22.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in 0.9 % sod chloride 30 unit/500 mL solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"97710521804","type":"NDC"}],"standard_charges":[{"gross_charge":91.92,"discounted_cash":22.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in 0.9 % sod chloride 30 unit/500 mL solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"71266500001","type":"NDC"}],"standard_charges":[{"gross_charge":91.92,"discounted_cash":22.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"oxytocin in 0.9 % sod chloride 30 unit/500 mL solution 500 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2590","type":"HCPCS"},{"code":"71266510001","type":"NDC"}],"standard_charges":[{"gross_charge":91.92,"discounted_cash":22.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sod suc(PF) per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9004704","type":"NDC"}],"standard_charges":[{"gross_charge":55.24,"discounted_cash":13.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sod suc(PF) per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9004703","type":"NDC"}],"standard_charges":[{"gross_charge":55.24,"discounted_cash":13.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sod suc(PF) per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9004725","type":"NDC"}],"standard_charges":[{"gross_charge":60.68,"discounted_cash":15.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sod suc(PF) per 125 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9004722","type":"NDC"}],"standard_charges":[{"gross_charge":60.68,"discounted_cash":15.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sod suc(PF) per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9003906","type":"NDC"}],"standard_charges":[{"gross_charge":34.72,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sod suc(PF) per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9003905","type":"NDC"}],"standard_charges":[{"gross_charge":34.72,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylPREDNISolone sod suc(PF) per 40 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"9003930","type":"NDC"}],"standard_charges":[{"gross_charge":38.13,"discounted_cash":9.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine 400 mg/10 mL (40 mg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"143925425","type":"NDC"}],"standard_charges":[{"gross_charge":38.22,"discounted_cash":9.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine 400 mg/10 mL (40 mg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"143925401","type":"NDC"}],"standard_charges":[{"gross_charge":38.22,"discounted_cash":9.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine 400 mg/10 mL (40 mg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"409910421","type":"NDC"}],"standard_charges":[{"gross_charge":31.56,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine 400 mg/10 mL (40 mg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"409910420","type":"NDC"}],"standard_charges":[{"gross_charge":31.56,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"69027702","type":"NDC"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":23.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"64253090030","type":"NDC"}],"standard_charges":[{"gross_charge":57.99,"discounted_cash":14.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"45963073357","type":"NDC"}],"standard_charges":[{"gross_charge":145.39,"discounted_cash":36.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409163140","type":"NDC"}],"standard_charges":[{"gross_charge":90.92,"discounted_cash":22.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70121230801","type":"NDC"}],"standard_charges":[{"gross_charge":65.8,"discounted_cash":16.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"781348714","type":"NDC"}],"standard_charges":[{"gross_charge":127.73,"discounted_cash":31.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"76329920205","type":"NDC"}],"standard_charges":[{"gross_charge":81.39,"discounted_cash":20.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"67457063910","type":"NDC"}],"standard_charges":[{"gross_charge":161.97,"discounted_cash":40.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"67457063900","type":"NDC"}],"standard_charges":[{"gross_charge":161.97,"discounted_cash":40.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"517231001","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":62.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"517231005","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":62.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose per 1 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"517232501","type":"NDC"}],"standard_charges":[{"gross_charge":457.19,"discounted_cash":114.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose per 1 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"517232510","type":"NDC"}],"standard_charges":[{"gross_charge":457.19,"discounted_cash":114.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glucagon (human recombinant) per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"597026010","type":"NDC"}],"standard_charges":[{"gross_charge":755.66,"discounted_cash":188.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glucagon (human recombinant) per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"597005345","type":"NDC"}],"standard_charges":[{"gross_charge":755.69,"discounted_cash":188.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"glucagon (human recombinant) per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1610","type":"HCPCS"},{"code":"597005301","type":"NDC"}],"standard_charges":[{"gross_charge":755.66,"discounted_cash":188.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone sod succ (PF) per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"9001104","type":"NDC"}],"standard_charges":[{"gross_charge":163.06,"discounted_cash":40.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone sod succ (PF) per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"9001103","type":"NDC"}],"standard_charges":[{"gross_charge":164.38,"discounted_cash":41.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone sod succ (PF) per 100 mg","drug_information":{"unit":1.6,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"9001612","type":"NDC"}],"standard_charges":[{"gross_charge":963.2,"discounted_cash":240.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70121230804","type":"NDC"}],"standard_charges":[{"gross_charge":65.8,"discounted_cash":16.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"64253090091","type":"NDC"}],"standard_charges":[{"gross_charge":63.42,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"69303120","type":"NDC"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":23.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"69400405","type":"NDC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"703504301","type":"NDC"}],"standard_charges":[{"gross_charge":92.69,"discounted_cash":23.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rabies vacc,human diploid (PF) per 1 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"49281025251","type":"NDC"}],"standard_charges":[{"gross_charge":3215.29,"discounted_cash":803.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rabies vacc,human diploid (PF) per 1 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"49281024658","type":"NDC"}],"standard_charges":[{"gross_charge":2471.73,"discounted_cash":617.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rabies vacc,human diploid (PF) per 1 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"49281024858","type":"NDC"}],"standard_charges":[{"gross_charge":2751.17,"discounted_cash":687.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rabies vacc,human diploid (PF) per 1 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90675","type":"HCPCS"},{"code":"49281025051","type":"NDC"}],"standard_charges":[{"gross_charge":2751.17,"discounted_cash":687.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetanus and diphther. tox (PF) per 0.5 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021588","type":"NDC"}],"standard_charges":[{"gross_charge":292.76,"discounted_cash":73.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tetanus and diphther. tox (PF) per 0.5 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"gross_charge":292.76,"discounted_cash":73.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409205020","type":"NDC"}],"standard_charges":[{"gross_charge":38.3,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409205001","type":"NDC"}],"standard_charges":[{"gross_charge":38.3,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010615","type":"NDC"}],"standard_charges":[{"gross_charge":45.96,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in water per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409672903","type":"NDC"}],"standard_charges":[{"gross_charge":38.3,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in NaCl (PF) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1643","type":"HCPCS"},{"code":"409762059","type":"NDC"}],"standard_charges":[{"gross_charge":30.64,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in NaCl (PF) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"338043304","type":"NDC"}],"standard_charges":[{"gross_charge":45.96,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in NaCl (PF) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1643","type":"HCPCS"},{"code":"409762049","type":"NDC"}],"standard_charges":[{"gross_charge":30.64,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in NaCl (PF) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"97710511305","type":"NDC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"69303020","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":15.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"63323088305","type":"NDC"}],"standard_charges":[{"gross_charge":39.91,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"69034302","type":"NDC"}],"standard_charges":[{"gross_charge":135.2,"discounted_cash":33.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"143908601","type":"NDC"}],"standard_charges":[{"gross_charge":268.1,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"70860020825","type":"NDC"}],"standard_charges":[{"gross_charge":229.8,"discounted_cash":57.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"45963073368","type":"NDC"}],"standard_charges":[{"gross_charge":160.86,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"25021020725","type":"NDC"}],"standard_charges":[{"gross_charge":97.86,"discounted_cash":24.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2021","type":"HCPCS"},{"code":"9514004","type":"NDC"}],"standard_charges":[{"gross_charge":482.58,"discounted_cash":120.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"69402625","type":"NDC"}],"standard_charges":[{"gross_charge":102.07,"discounted_cash":25.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"63323088330","type":"NDC"}],"standard_charges":[{"gross_charge":255.46,"discounted_cash":63.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinCRIStine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030916","type":"NDC"}],"standard_charges":[{"gross_charge":95.37,"discounted_cash":23.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinCRIStine per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"703441211","type":"NDC"}],"standard_charges":[{"gross_charge":214.4,"discounted_cash":53.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in NaCl (PF) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"264987200","type":"NDC"}],"standard_charges":[{"gross_charge":45.96,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in NaCl (PF) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"409222201","type":"NDC"}],"standard_charges":[{"gross_charge":30.64,"discounted_cash":7.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in NaCl (PF) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323051910","type":"NDC"}],"standard_charges":[{"gross_charge":53.62,"discounted_cash":13.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in NaCl (PF) per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323051901","type":"NDC"}],"standard_charges":[{"gross_charge":53.62,"discounted_cash":13.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXOrubicin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"69303220","type":"NDC"}],"standard_charges":[{"gross_charge":135.2,"discounted_cash":33.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"linezolid per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2021","type":"HCPCS"},{"code":"9514001","type":"NDC"}],"standard_charges":[{"gross_charge":234.4,"discounted_cash":58.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, ramucirumab, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"2767801","type":"NDC"}],"standard_charges":[{"gross_charge":51844.8,"discounted_cash":12961.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, ramucirumab, 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"2766901","type":"NDC"}],"standard_charges":[{"gross_charge":11242.43,"discounted_cash":2810.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"23155051831","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70069080610","type":"NDC"}],"standard_charges":[{"gross_charge":26.27,"discounted_cash":6.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70069080601","type":"NDC"}],"standard_charges":[{"gross_charge":26.27,"discounted_cash":6.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70700017223","type":"NDC"}],"standard_charges":[{"gross_charge":37.61,"discounted_cash":9.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70700017222","type":"NDC"}],"standard_charges":[{"gross_charge":37.61,"discounted_cash":9.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70121147907","type":"NDC"}],"standard_charges":[{"gross_charge":34.93,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70121147901","type":"NDC"}],"standard_charges":[{"gross_charge":34.93,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"43598052911","type":"NDC"}],"standard_charges":[{"gross_charge":99.27,"discounted_cash":24.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"517113405","type":"NDC"}],"standard_charges":[{"gross_charge":270.78,"discounted_cash":67.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"517113401","type":"NDC"}],"standard_charges":[{"gross_charge":270.78,"discounted_cash":67.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"42023018901","type":"NDC"}],"standard_charges":[{"gross_charge":25.89,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"63323041510","type":"NDC"}],"standard_charges":[{"gross_charge":202.99,"discounted_cash":50.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"76014000310","type":"NDC"}],"standard_charges":[{"gross_charge":130.83,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"76014000333","type":"NDC"}],"standard_charges":[{"gross_charge":130.83,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143933310","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"neostigmine 1 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"23155051841","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143933301","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"409116301","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046757","type":"NDC"}],"standard_charges":[{"gross_charge":107.62,"discounted_cash":26.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bortezomib (velcade), 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"71288011810","type":"NDC"}],"standard_charges":[{"gross_charge":134.43,"discounted_cash":33.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bortezomib (velcade), 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"70710141101","type":"NDC"}],"standard_charges":[{"gross_charge":2297.92,"discounted_cash":574.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bortezomib (velcade), 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"55150033701","type":"NDC"}],"standard_charges":[{"gross_charge":339.57,"discounted_cash":84.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bortezomib (velcade), 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9044","type":"HCPCS"},{"code":"50742048401","type":"NDC"}],"standard_charges":[{"gross_charge":462.28,"discounted_cash":115.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bortezomib (velcade), 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9044","type":"HCPCS"},{"code":"25021024410","type":"NDC"}],"standard_charges":[{"gross_charge":207.05,"discounted_cash":51.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric carboxymaltose 50 mg iron/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"517065002","type":"NDC"}],"standard_charges":[{"gross_charge":6353.97,"discounted_cash":1588.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric carboxymaltose 50 mg iron/mL solution 15 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"517065001","type":"NDC"}],"standard_charges":[{"gross_charge":7900.41,"discounted_cash":1975.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"golimumab 12.5 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"gross_charge":14923.52,"discounted_cash":3730.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"70069075325","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"70069075301","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"71288072652","type":"NDC"}],"standard_charges":[{"gross_charge":20.3,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"143932901","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046701","type":"NDC"}],"standard_charges":[{"gross_charge":107.62,"discounted_cash":26.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150025050","type":"NDC"}],"standard_charges":[{"gross_charge":47.49,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"409116318","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"409161050","type":"NDC"}],"standard_charges":[{"gross_charge":40.98,"discounted_cash":10.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143933010","type":"NDC"}],"standard_charges":[{"gross_charge":7.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143933001","type":"NDC"}],"standard_charges":[{"gross_charge":7.97,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046401","type":"NDC"}],"standard_charges":[{"gross_charge":59.67,"discounted_cash":14.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"409021202","type":"NDC"}],"standard_charges":[{"gross_charge":34.78,"discounted_cash":8.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"143971010","type":"NDC"}],"standard_charges":[{"gross_charge":105.02,"discounted_cash":26.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"97710505902","type":"NDC"}],"standard_charges":[{"gross_charge":125.62,"discounted_cash":31.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"409204501","type":"NDC"}],"standard_charges":[{"gross_charge":47.49,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"55150028710","type":"NDC"}],"standard_charges":[{"gross_charge":26.04,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"55150028701","type":"NDC"}],"standard_charges":[{"gross_charge":26.04,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"143971901","type":"NDC"}],"standard_charges":[{"gross_charge":263.5,"discounted_cash":65.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"338601048","type":"NDC"}],"standard_charges":[{"gross_charge":99.58,"discounted_cash":24.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"409277623","type":"NDC"}],"standard_charges":[{"gross_charge":62.05,"discounted_cash":15.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"31722027734","type":"NDC"}],"standard_charges":[{"gross_charge":21.83,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"31722027730","type":"NDC"}],"standard_charges":[{"gross_charge":21.83,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409116519","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150017230","type":"NDC"}],"standard_charges":[{"gross_charge":56.53,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150017110","type":"NDC"}],"standard_charges":[{"gross_charge":39.99,"discounted_cash":10.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323047217","type":"NDC"}],"standard_charges":[{"gross_charge":40.14,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"409021211","type":"NDC"}],"standard_charges":[{"gross_charge":34.78,"discounted_cash":8.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"143971001","type":"NDC"}],"standard_charges":[{"gross_charge":105.02,"discounted_cash":26.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"143932601","type":"NDC"}],"standard_charges":[{"gross_charge":35.24,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"143932610","type":"NDC"}],"standard_charges":[{"gross_charge":35.24,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409115918","type":"NDC"}],"standard_charges":[{"gross_charge":14.63,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409115919","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409155919","type":"NDC"}],"standard_charges":[{"gross_charge":34.7,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409155918","type":"NDC"}],"standard_charges":[{"gross_charge":29.34,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150016830","type":"NDC"}],"standard_charges":[{"gross_charge":34.01,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150016710","type":"NDC"}],"standard_charges":[{"gross_charge":33.78,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046417","type":"NDC"}],"standard_charges":[{"gross_charge":59.67,"discounted_cash":14.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bortezomib (velcade), 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"143909801","type":"NDC"}],"standard_charges":[{"gross_charge":186.6,"discounted_cash":46.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046437","type":"NDC"}],"standard_charges":[{"gross_charge":76.52,"discounted_cash":19.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409155930","type":"NDC"}],"standard_charges":[{"gross_charge":34.7,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409155910","type":"NDC"}],"standard_charges":[{"gross_charge":29.34,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409115902","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409115901","type":"NDC"}],"standard_charges":[{"gross_charge":14.63,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"63323061710","type":"NDC"}],"standard_charges":[{"gross_charge":105.02,"discounted_cash":26.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"71288020011","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"milrinone per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"71288020010","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046431","type":"NDC"}],"standard_charges":[{"gross_charge":36.77,"discounted_cash":9.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron sucrose per 1 mg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"781348770","type":"NDC"}],"standard_charges":[{"gross_charge":127.73,"discounted_cash":31.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bortezomib (velcade), 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"72205018301","type":"NDC"}],"standard_charges":[{"gross_charge":115.97,"discounted_cash":28.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bortezomib (velcade), 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"63020004901","type":"NDC"}],"standard_charges":[{"gross_charge":12248.26,"discounted_cash":3062.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine PF 20 mg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323073916","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine PF 20 mg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"67457043322","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine PF 20 mg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"67457043300","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine PF 20 mg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"641602201","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 25 mg/mL solution 40 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"97710512701","type":"NDC"}],"standard_charges":[{"gross_charge":184.45,"discounted_cash":46.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 25 mg/mL INTRATHECAL 20ml (IR use only) 25 mg/mL solution 20 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"97710512601","type":"NDC"}],"standard_charges":[{"gross_charge":92.23,"discounted_cash":23.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"70515026010","type":"NDC"}],"standard_charges":[{"gross_charge":983.27,"discounted_cash":245.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin per 0.5 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"781305972","type":"NDC"}],"standard_charges":[{"gross_charge":4.53,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"641141031","type":"NDC"}],"standard_charges":[{"gross_charge":51.4,"discounted_cash":12.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"digoxin per 0.5 mg","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"781305995","type":"NDC"}],"standard_charges":[{"gross_charge":4.45,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"obinutuzumab per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9301","type":"HCPCS"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":65808.59,"discounted_cash":16452.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tbo-filgrastim per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091212","type":"NDC"}],"standard_charges":[{"gross_charge":716.75,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tbo-filgrastim per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":716.75,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tbo-filgrastim per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"gross_charge":447.88,"discounted_cash":111.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323010450","type":"NDC"}],"standard_charges":[{"gross_charge":1162.41,"discounted_cash":290.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine PF 20 mg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323073911","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323010425","type":"NDC"}],"standard_charges":[{"gross_charge":581.01,"discounted_cash":145.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine PF 20 mg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860075102","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine PF 20 mg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323073941","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"perflutren lipid microspheres 1.1 mg/mL suspension 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001104","type":"NDC"}],"standard_charges":[{"gross_charge":1205.99,"discounted_cash":301.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"perflutren lipid microspheres 1.1 mg/mL suspension 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001101","type":"NDC"}],"standard_charges":[{"gross_charge":1205.99,"discounted_cash":301.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"perflutren lipid microspheres 1.1 mg/mL suspension 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001116","type":"NDC"}],"standard_charges":[{"gross_charge":991.28,"discounted_cash":247.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 5 mcg/mL solution 250 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"97710516003","type":"NDC"}],"standard_charges":[{"gross_charge":70.86,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fentaNYL 5 mcg/mL solution 250 mL Bag","drug_information":{"unit":1.04,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"70092144405","type":"NDC"}],"standard_charges":[{"gross_charge":159.33,"discounted_cash":39.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 50 mg/mL solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409113405","type":"NDC"}],"standard_charges":[{"gross_charge":219.08,"discounted_cash":54.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine 50 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409113403","type":"NDC"}],"standard_charges":[{"gross_charge":92.07,"discounted_cash":23.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone sod succinate per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"69097000467","type":"NDC"}],"standard_charges":[{"gross_charge":111.91,"discounted_cash":27.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydrocortisone sod succinate per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"9082501","type":"NDC"}],"standard_charges":[{"gross_charge":130.45,"discounted_cash":32.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL (10 %) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517671010","type":"NDC"}],"standard_charges":[{"gross_charge":61.36,"discounted_cash":15.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium chloride 100 mg/mL (10 %) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517671001","type":"NDC"}],"standard_charges":[{"gross_charge":61.36,"discounted_cash":15.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0167","type":"HCPCS"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":83.19,"discounted_cash":20.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0167","type":"HCPCS"},{"code":"409493311","type":"NDC"}],"standard_charges":[{"gross_charge":73.38,"discounted_cash":18.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0167","type":"HCPCS"},{"code":"409493301","type":"NDC"}],"standard_charges":[{"gross_charge":73.38,"discounted_cash":18.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine PF 20 mg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"famotidine PF 20 mg/2 mL solution 2 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70860075141","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323010406","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":36.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"143951201","type":"NDC"}],"standard_charges":[{"gross_charge":1117.59,"discounted_cash":279.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"143951101","type":"NDC"}],"standard_charges":[{"gross_charge":560.52,"discounted_cash":140.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione (vitamin K1) 1 mg/0.5 mL solution 0.5 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"409915731","type":"NDC"}],"standard_charges":[{"gross_charge":26.33,"discounted_cash":6.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione (vitamin K1) 1 mg/0.5 mL solution 0.5 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"409915701","type":"NDC"}],"standard_charges":[{"gross_charge":26.33,"discounted_cash":6.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65219081813","type":"NDC"}],"standard_charges":[{"gross_charge":181.16,"discounted_cash":45.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65219081803","type":"NDC"}],"standard_charges":[{"gross_charge":181.16,"discounted_cash":45.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288020411","type":"NDC"}],"standard_charges":[{"gross_charge":151.29,"discounted_cash":37.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288020410","type":"NDC"}],"standard_charges":[{"gross_charge":151.29,"discounted_cash":37.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150018310","type":"NDC"}],"standard_charges":[{"gross_charge":65.26,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150018301","type":"NDC"}],"standard_charges":[{"gross_charge":65.26,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47335088244","type":"NDC"}],"standard_charges":[{"gross_charge":69.78,"discounted_cash":17.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"47335088240","type":"NDC"}],"standard_charges":[{"gross_charge":69.78,"discounted_cash":17.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517073510","type":"NDC"}],"standard_charges":[{"gross_charge":166.38,"discounted_cash":41.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517073501","type":"NDC"}],"standard_charges":[{"gross_charge":166.38,"discounted_cash":41.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143968901","type":"NDC"}],"standard_charges":[{"gross_charge":65.26,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143954201","type":"NDC"}],"standard_charges":[{"gross_charge":113.98,"discounted_cash":28.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Nicardipine, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143968910","type":"NDC"}],"standard_charges":[{"gross_charge":65.26,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione (vitamin K1) 1 mg/0.5 mL solution 0.5 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"409915750","type":"NDC"}],"standard_charges":[{"gross_charge":26.33,"discounted_cash":6.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409116001","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409158750","type":"NDC"}],"standard_charges":[{"gross_charge":5.21,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046557","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":2.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"143951001","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":36.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011411","type":"NDC"}],"standard_charges":[{"gross_charge":615.48,"discounted_cash":153.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011408","type":"NDC"}],"standard_charges":[{"gross_charge":308.7,"discounted_cash":77.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"703565701","type":"NDC"}],"standard_charges":[{"gross_charge":1117.59,"discounted_cash":279.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"703565601","type":"NDC"}],"standard_charges":[{"gross_charge":560.52,"discounted_cash":140.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"703565301","type":"NDC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":36.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"etoposide per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011431","type":"NDC"}],"standard_charges":[{"gross_charge":63.42,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bortezomib (velcade), 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"31722030331","type":"NDC"}],"standard_charges":[{"gross_charge":117.89,"discounted_cash":29.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70069075225","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70594011601","type":"NDC"}],"standard_charges":[{"gross_charge":2.3,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288072352","type":"NDC"}],"standard_charges":[{"gross_charge":3.22,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143932810","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143932801","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323046501","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":2.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150024950","type":"NDC"}],"standard_charges":[{"gross_charge":5.71,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409116018","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70069075201","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323031119","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323031159","type":"NDC"}],"standard_charges":[{"gross_charge":50.17,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323031166","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carfilzomib 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"76075010301","type":"NDC"}],"standard_charges":[{"gross_charge":4504.08,"discounted_cash":1126.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pegfilgrastim-jmdb 6 mg/0.6 mL syringe 0.6 mL Syringe","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"83257000541","type":"NDC"}],"standard_charges":[{"gross_charge":10746.02,"discounted_cash":2686.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bleomycin per 15 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"61703032322","type":"NDC"}],"standard_charges":[{"gross_charge":399.32,"discounted_cash":99.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bleomycin per 15 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"71288010720","type":"NDC"}],"standard_charges":[{"gross_charge":403.53,"discounted_cash":100.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bleomycin per 15 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"143924101","type":"NDC"}],"standard_charges":[{"gross_charge":599.4,"discounted_cash":149.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bleomycin per 15 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"703315501","type":"NDC"}],"standard_charges":[{"gross_charge":495.76,"discounted_cash":123.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bleomycin per 15 Units","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9040","type":"HCPCS"},{"code":"63323013720","type":"NDC"}],"standard_charges":[{"gross_charge":597.02,"discounted_cash":149.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa-epbx 40,000 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69130904","type":"NDC"}],"standard_charges":[{"gross_charge":2785.83,"discounted_cash":696.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa-epbx 40,000 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69130901","type":"NDC"}],"standard_charges":[{"gross_charge":2785.83,"discounted_cash":696.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69130810","type":"NDC"}],"standard_charges":[{"gross_charge":696.46,"discounted_cash":174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69130801","type":"NDC"}],"standard_charges":[{"gross_charge":696.46,"discounted_cash":174.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa-epbx 4,000 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69130710","type":"NDC"}],"standard_charges":[{"gross_charge":278.58,"discounted_cash":69.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa-epbx 4,000 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69130701","type":"NDC"}],"standard_charges":[{"gross_charge":278.58,"discounted_cash":69.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa-epbx 2,000 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69130510","type":"NDC"}],"standard_charges":[{"gross_charge":139.29,"discounted_cash":34.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa-epbx 2,000 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"69130501","type":"NDC"}],"standard_charges":[{"gross_charge":139.29,"discounted_cash":34.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carfilzomib 10 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"76075010321","type":"NDC"}],"standard_charges":[{"gross_charge":4816.0,"discounted_cash":1204.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron dextran complex 50 mg/mL solution 2 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"23608210","type":"NDC"}],"standard_charges":[{"gross_charge":135.08,"discounted_cash":33.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-aafi 300 mcg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"69029101","type":"NDC"}],"standard_charges":[{"gross_charge":1623.0,"discounted_cash":405.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-aafi 480 mcg/0.8 mL syringe 0.8 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"69029201","type":"NDC"}],"standard_charges":[{"gross_charge":2596.82,"discounted_cash":649.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topotecan per 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"63323076210","type":"NDC"}],"standard_charges":[{"gross_charge":2196.12,"discounted_cash":549.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atezolizumab 1,200 mg/20 mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091701","type":"NDC"}],"standard_charges":[{"gross_charge":88359.94,"discounted_cash":22089.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"338358301","type":"NDC"}],"standard_charges":[{"gross_charge":84.26,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxyprogesterone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"55150030901","type":"NDC"}],"standard_charges":[{"gross_charge":784.23,"discounted_cash":196.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxyprogesterone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"517176701","type":"NDC"}],"standard_charges":[{"gross_charge":1194.12,"discounted_cash":298.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"hydroxyprogesterone per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"64011024702","type":"NDC"}],"standard_charges":[{"gross_charge":6150.98,"discounted_cash":1537.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"63323012594","type":"NDC"}],"standard_charges":[{"gross_charge":138.11,"discounted_cash":34.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457046201","type":"NDC"}],"standard_charges":[{"gross_charge":134.74,"discounted_cash":33.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"63323010294","type":"NDC"}],"standard_charges":[{"gross_charge":42.74,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457046420","type":"NDC"}],"standard_charges":[{"gross_charge":42.74,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"63323010213","type":"NDC"}],"standard_charges":[{"gross_charge":188.28,"discounted_cash":47.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bendamustine hcl (bendeka), 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9033","type":"HCPCS"},{"code":"42367052025","type":"NDC"}],"standard_charges":[{"gross_charge":14913.41,"discounted_cash":3728.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bendamustine hcl (bendeka), 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9033","type":"HCPCS"},{"code":"63459034804","type":"NDC"}],"standard_charges":[{"gross_charge":12932.93,"discounted_cash":3233.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"necitumumab 800 mg/50 mL solution 50 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9475","type":"HCPCS"},{"code":"2771601","type":"NDC"}],"standard_charges":[{"gross_charge":33083.16,"discounted_cash":8270.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-aafi 480 mcg/0.8 mL syringe 0.8 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"69029210","type":"NDC"}],"standard_charges":[{"gross_charge":2596.83,"discounted_cash":649.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-aafi 300 mcg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"69029110","type":"NDC"}],"standard_charges":[{"gross_charge":1623.02,"discounted_cash":405.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron dextran complex 50 mg/mL solution 2 mL Vial","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"23608201","type":"NDC"}],"standard_charges":[{"gross_charge":135.08,"discounted_cash":33.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"iron dextran complex 50 mg/mL solution 2 mL Vial","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"52544093107","type":"NDC"}],"standard_charges":[{"gross_charge":49.31,"discounted_cash":12.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"elotuzumab 400 mg recon soln 1 each Vial","drug_information":{"unit":1.002,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9176","type":"HCPCS"},{"code":"3452211","type":"NDC"}],"standard_charges":[{"gross_charge":23230.05,"discounted_cash":5807.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meningococcal conjugate vaccine (A component, 2 of 2) 10 mcg /0.5 mL (final) recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90734","type":"HCPCS"},{"code":"58160095801","type":"NDC"}],"standard_charges":[{"gross_charge":826.58,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime-avibactam 2.5 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0714","type":"HCPCS"},{"code":"456270010","type":"NDC"}],"standard_charges":[{"gross_charge":2860.9,"discounted_cash":715.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefTAZidime-avibactam 2.5 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0714","type":"HCPCS"},{"code":"456270001","type":"NDC"}],"standard_charges":[{"gross_charge":2860.9,"discounted_cash":715.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE per 50 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"70710184907","type":"NDC"}],"standard_charges":[{"gross_charge":191.41,"discounted_cash":47.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE per 50 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"70710184901","type":"NDC"}],"standard_charges":[{"gross_charge":191.41,"discounted_cash":47.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE per 50 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"641139735","type":"NDC"}],"standard_charges":[{"gross_charge":320.46,"discounted_cash":80.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"641139831","type":"NDC"}],"standard_charges":[{"gross_charge":183.59,"discounted_cash":45.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"chlorproMAZINE per 50 mg","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"641139731","type":"NDC"}],"standard_charges":[{"gross_charge":320.46,"discounted_cash":80.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, pembrolizumab, 1mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"6302604","type":"NDC"}],"standard_charges":[{"gross_charge":44180.0,"discounted_cash":11045.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, pembrolizumab, 1mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"6302602","type":"NDC"}],"standard_charges":[{"gross_charge":43821.27,"discounted_cash":10955.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, pembrolizumab, 1mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"6302601","type":"NDC"}],"standard_charges":[{"gross_charge":43821.27,"discounted_cash":10955.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, pegfilgrastim, excludes biosimilar, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"gross_charge":32114.55,"discounted_cash":8028.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole ER 400 mg suspension,extended rel syring 1 each Syringe","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0401","type":"HCPCS"},{"code":"59148007280","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole ER 300 mg suspension,extended rel syring 1 each Syringe","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0401","type":"HCPCS"},{"code":"59148004580","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB PER 1 MG","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"3377412","type":"NDC"}],"standard_charges":[{"gross_charge":24792.36,"discounted_cash":6198.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meningococcal conjugate vaccine (C,Y,W-135 component, 1 of 2) 5 mcg x 3/ 0.5 mL (final) recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90734","type":"HCPCS"},{"code":"58160095901","type":"NDC"}],"standard_charges":[{"gross_charge":826.58,"discounted_cash":206.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-sndz 480 mcg/0.8 mL syringe 0.8 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"gross_charge":3253.28,"discounted_cash":813.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-sndz 480 mcg/0.8 mL syringe 0.8 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032610","type":"NDC"}],"standard_charges":[{"gross_charge":3253.3,"discounted_cash":813.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-sndz 480 mcg/0.8 mL syringe 0.8 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032605","type":"NDC"}],"standard_charges":[{"gross_charge":3253.3,"discounted_cash":813.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"elotuzumab 300 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9176","type":"HCPCS"},{"code":"3229111","type":"NDC"}],"standard_charges":[{"gross_charge":17387.97,"discounted_cash":4346.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"daratumumab 20 mg/mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050220","type":"NDC"}],"standard_charges":[{"gross_charge":22474.13,"discounted_cash":5618.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"daratumumab 20 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050205","type":"NDC"}],"standard_charges":[{"gross_charge":5926.47,"discounted_cash":1481.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan liposomaL 4.3 mg/mL dispersion 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"C9474","type":"HCPCS"},{"code":"15054004301","type":"NDC"}],"standard_charges":[{"gross_charge":22204.35,"discounted_cash":5551.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 1 mg/mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"65219065010","type":"NDC"}],"standard_charges":[{"gross_charge":60.51,"discounted_cash":15.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 1 mg/mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"65219065002","type":"NDC"}],"standard_charges":[{"gross_charge":60.51,"discounted_cash":15.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 1 mg/mL solution 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"143938010","type":"NDC"}],"standard_charges":[{"gross_charge":189.97,"discounted_cash":47.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topotecan per 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"16729015131","type":"NDC"}],"standard_charges":[{"gross_charge":297.51,"discounted_cash":74.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 1 mg/mL solution 100 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"143938001","type":"NDC"}],"standard_charges":[{"gross_charge":189.97,"discounted_cash":47.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 1 mg/mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"44567061101","type":"NDC"}],"standard_charges":[{"gross_charge":134.82,"discounted_cash":33.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 1 mg/mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70092141836","type":"NDC"}],"standard_charges":[{"gross_charge":153.97,"discounted_cash":38.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trabectedin 1 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9480","type":"HCPCS"},{"code":"59676061001","type":"NDC"}],"standard_charges":[{"gross_charge":28189.72,"discounted_cash":7047.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-sndz 300 mcg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031805","type":"NDC"}],"standard_charges":[{"gross_charge":2033.32,"discounted_cash":508.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-sndz 300 mcg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031810","type":"NDC"}],"standard_charges":[{"gross_charge":2033.32,"discounted_cash":508.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim-sndz 300 mcg/0.5 mL syringe 0.5 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031801","type":"NDC"}],"standard_charges":[{"gross_charge":2033.27,"discounted_cash":508.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 1 mg/mL solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"44567061110","type":"NDC"}],"standard_charges":[{"gross_charge":134.82,"discounted_cash":33.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"nivolumab per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"3377211","type":"NDC"}],"standard_charges":[{"gross_charge":9693.27,"discounted_cash":2423.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topotecan per 0.1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"63323076294","type":"NDC"}],"standard_charges":[{"gross_charge":319.27,"discounted_cash":79.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carfilzomib 30 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"76075010201","type":"NDC"}],"standard_charges":[{"gross_charge":13512.24,"discounted_cash":3378.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB PER 1 MG","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"3373413","type":"NDC"}],"standard_charges":[{"gross_charge":59501.84,"discounted_cash":14875.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arsenic trioxide 2 mg/mL solution 6 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"70710161006","type":"NDC"}],"standard_charges":[{"gross_charge":814.46,"discounted_cash":203.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"arsenic trioxide 2 mg/mL solution 6 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"70710161001","type":"NDC"}],"standard_charges":[{"gross_charge":814.46,"discounted_cash":203.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem HCL in NaCl,iso-osm 100 mg/100 mL (1 mg/mL) solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1163","type":"HCPCS"},{"code":"44567066210","type":"NDC"}],"standard_charges":[{"gross_charge":192.27,"discounted_cash":48.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dilTIAZem HCL in NaCl,iso-osm 100 mg/100 mL (1 mg/mL) solution 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1163","type":"HCPCS"},{"code":"44567066201","type":"NDC"}],"standard_charges":[{"gross_charge":192.27,"discounted_cash":48.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNOrubicin-cytarabine lipos 44-100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9153","type":"HCPCS"},{"code":"68727074502","type":"NDC"}],"standard_charges":[{"gross_charge":82272.84,"discounted_cash":20568.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Infliximab-ABDA, Biosimilar, (Renflexis), 10mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016299","type":"NDC"}],"standard_charges":[{"gross_charge":5192.56,"discounted_cash":1298.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, Infliximab-ABDA, Biosimilar, (Renflexis), 10mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5104","type":"HCPCS"},{"code":"78206016201","type":"NDC"}],"standard_charges":[{"gross_charge":5192.56,"discounted_cash":1298.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cemiplimab-rwlc 50 mg/mL solution 7 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9119","type":"HCPCS"},{"code":"61755000801","type":"NDC"}],"standard_charges":[{"gross_charge":81044.65,"discounted_cash":20261.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"durvalumab 50 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"310461150","type":"NDC"}],"standard_charges":[{"gross_charge":32171.39,"discounted_cash":8042.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"durvalumab 50 mg/mL solution 2.4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"310450012","type":"NDC"}],"standard_charges":[{"gross_charge":7721.13,"discounted_cash":1930.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, clindamycin phosphate, 300 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"338955350","type":"NDC"}],"standard_charges":[{"gross_charge":94.6,"discounted_cash":23.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tenecteplase per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242017601","type":"NDC"}],"standard_charges":[{"gross_charge":59273.23,"discounted_cash":14818.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trastuzumab 150 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9355","type":"HCPCS"},{"code":"50242013201","type":"NDC"}],"standard_charges":[{"gross_charge":11907.62,"discounted_cash":2976.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rabies immune globulin (PF) 300 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031801","type":"NDC"}],"standard_charges":[{"gross_charge":3423.41,"discounted_cash":855.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rabies immune globulin (PF) 300 unit/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031810","type":"NDC"}],"standard_charges":[{"gross_charge":3423.41,"discounted_cash":855.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISplatin per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"44567053001","type":"NDC"}],"standard_charges":[{"gross_charge":3868.3,"discounted_cash":967.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"trastuzumab-hyaluronidase-oysk 600 mg-10,000 unit/5 mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9356","type":"HCPCS"},{"code":"50242007701","type":"NDC"}],"standard_charges":[{"gross_charge":35694.14,"discounted_cash":8923.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"atezolizumab 840 mg/14 mL (60 mg/mL) solution 14 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091801","type":"NDC"}],"standard_charges":[{"gross_charge":60181.37,"discounted_cash":15045.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"55150047110","type":"NDC"}],"standard_charges":[{"gross_charge":126.88,"discounted_cash":31.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"55150047101","type":"NDC"}],"standard_charges":[{"gross_charge":126.88,"discounted_cash":31.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3374","type":"HCPCS"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"gross_charge":89.99,"discounted_cash":22.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3374","type":"HCPCS"},{"code":"67457082312","type":"NDC"}],"standard_charges":[{"gross_charge":89.99,"discounted_cash":22.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pegfilgrastim-cbqv 6 mg/0.6 mL syringe 0.6 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"70114010101","type":"NDC"}],"standard_charges":[{"gross_charge":30941.11,"discounted_cash":7735.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"409351511","type":"NDC"}],"standard_charges":[{"gross_charge":161.68,"discounted_cash":40.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3373","type":"HCPCS"},{"code":"409351501","type":"NDC"}],"standard_charges":[{"gross_charge":161.68,"discounted_cash":40.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3374","type":"HCPCS"},{"code":"67457082499","type":"NDC"}],"standard_charges":[{"gross_charge":63.71,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3374","type":"HCPCS"},{"code":"67457082415","type":"NDC"}],"standard_charges":[{"gross_charge":63.71,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ganciclovir sodium 50 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"25021018511","type":"NDC"}],"standard_charges":[{"gross_charge":328.15,"discounted_cash":82.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ganciclovir sodium 50 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1570","type":"HCPCS"},{"code":"25021018510","type":"NDC"}],"standard_charges":[{"gross_charge":287.1,"discounted_cash":71.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rabies immune globulin (PF) 300 unit/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031850","type":"NDC"}],"standard_charges":[{"gross_charge":17116.96,"discounted_cash":4279.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rabies immune globulin (PF) 300 unit/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031805","type":"NDC"}],"standard_charges":[{"gross_charge":17116.96,"discounted_cash":4279.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphtheria-tetanus-polio-haemophilus B vaccine per 0.5 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90698","type":"HCPCS"},{"code":"49281054458","type":"NDC"}],"standard_charges":[{"gross_charge":821.08,"discounted_cash":205.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphtheria-tetanus-polio-haemophilus B vaccine per 0.5 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90698","type":"HCPCS"},{"code":"49281054858","type":"NDC"}],"standard_charges":[{"gross_charge":705.35,"discounted_cash":176.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphtheria-tetanus-polio-haemophilus B vaccine per 0.5 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90698","type":"HCPCS"},{"code":"49281054515","type":"NDC"}],"standard_charges":[{"gross_charge":705.35,"discounted_cash":176.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"409350601","type":"NDC"}],"standard_charges":[{"gross_charge":82.84,"discounted_cash":20.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567014510","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567014501","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567040010","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567040001","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"70121145407","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"70121145401","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"781300095","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"781300094","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"409350511","type":"NDC"}],"standard_charges":[{"gross_charge":41.2,"discounted_cash":10.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050725","type":"NDC"}],"standard_charges":[{"gross_charge":26.73,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050720","type":"NDC"}],"standard_charges":[{"gross_charge":28.79,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem 500 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"409350501","type":"NDC"}],"standard_charges":[{"gross_charge":41.2,"discounted_cash":10.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cidofovir 75 mg/mL solution 5 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0740","type":"HCPCS"},{"code":"23155021631","type":"NDC"}],"standard_charges":[{"gross_charge":4384.05,"discounted_cash":1096.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050830","type":"NDC"}],"standard_charges":[{"gross_charge":54.12,"discounted_cash":13.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050825","type":"NDC"}],"standard_charges":[{"gross_charge":41.35,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"781309894","type":"NDC"}],"standard_charges":[{"gross_charge":32.92,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"781309895","type":"NDC"}],"standard_charges":[{"gross_charge":32.92,"discounted_cash":8.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"avelumab 20 mg/mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9023","type":"HCPCS"},{"code":"44087353501","type":"NDC"}],"standard_charges":[{"gross_charge":15384.73,"discounted_cash":3846.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"procainamide 100 mg/mL syringe 10 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"76329339905","type":"NDC"}],"standard_charges":[{"gross_charge":379.63,"discounted_cash":94.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"inFLIXimab-dyyb 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5103","type":"HCPCS"},{"code":"69080901","type":"NDC"}],"standard_charges":[{"gross_charge":3520.23,"discounted_cash":880.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylene blue 0.5 % (5 mg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"14789011907","type":"NDC"}],"standard_charges":[{"gross_charge":413.87,"discounted_cash":103.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylene blue 0.5 % (5 mg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"14789011905","type":"NDC"}],"standard_charges":[{"gross_charge":413.87,"discounted_cash":103.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylene blue 0.5 % (5 mg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"70710183801","type":"NDC"}],"standard_charges":[{"gross_charge":2140.82,"discounted_cash":535.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylene blue 0.5 % (5 mg/mL) solution 10 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"517037405","type":"NDC"}],"standard_charges":[{"gross_charge":978.26,"discounted_cash":244.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methylene blue 0.5 % (5 mg/mL) solution 10 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"517037401","type":"NDC"}],"standard_charges":[{"gross_charge":978.26,"discounted_cash":244.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567014601","type":"NDC"}],"standard_charges":[{"gross_charge":33.54,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"70594007602","type":"NDC"}],"standard_charges":[{"gross_charge":41.29,"discounted_cash":10.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"70594007601","type":"NDC"}],"standard_charges":[{"gross_charge":41.29,"discounted_cash":10.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050801","type":"NDC"}],"standard_charges":[{"gross_charge":54.12,"discounted_cash":13.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567040110","type":"NDC"}],"standard_charges":[{"gross_charge":34.07,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567040101","type":"NDC"}],"standard_charges":[{"gross_charge":34.07,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"gross_charge":27.12,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"meropenem per 100 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567014610","type":"NDC"}],"standard_charges":[{"gross_charge":33.54,"discounted_cash":8.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, bupivacaine, not otherwise specified, 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323047237","type":"NDC"}],"standard_charges":[{"gross_charge":63.88,"discounted_cash":15.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceftolozane/tazobactam 50-25 mg Inj","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0695","type":"HCPCS"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"gross_charge":1332.26,"discounted_cash":333.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"43598091425","type":"NDC"}],"standard_charges":[{"gross_charge":20.69,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"781345070","type":"NDC"}],"standard_charges":[{"gross_charge":25.28,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"143992390","type":"NDC"}],"standard_charges":[{"gross_charge":18.71,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin 10 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"25021010269","type":"NDC"}],"standard_charges":[{"gross_charge":41.34,"discounted_cash":10.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin 10 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"143998391","type":"NDC"}],"standard_charges":[{"gross_charge":89.89,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin 10 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567070810","type":"NDC"}],"standard_charges":[{"gross_charge":50.39,"discounted_cash":12.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin 10 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"25021010299","type":"NDC"}],"standard_charges":[{"gross_charge":47.27,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin 10 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"781345246","type":"NDC"}],"standard_charges":[{"gross_charge":62.8,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin 10 gram recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"143998303","type":"NDC"}],"standard_charges":[{"gross_charge":89.89,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"63323023710","type":"NDC"}],"standard_charges":[{"gross_charge":15.86,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567012025","type":"NDC"}],"standard_charges":[{"gross_charge":6.99,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"gross_charge":7.31,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505614200","type":"NDC"}],"standard_charges":[{"gross_charge":7.31,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567070725","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"781345170","type":"NDC"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"25021010110","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"781345095","type":"NDC"}],"standard_charges":[{"gross_charge":25.28,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505074905","type":"NDC"}],"standard_charges":[{"gross_charge":12.59,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"25021010010","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"25021010066","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine (diagnostic) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"23155025831","type":"NDC"}],"standard_charges":[{"gross_charge":197.02,"discounted_cash":49.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine (diagnostic) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"55150019201","type":"NDC"}],"standard_charges":[{"gross_charge":144.62,"discounted_cash":36.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine (diagnostic) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"55150019220","type":"NDC"}],"standard_charges":[{"gross_charge":122.41,"discounted_cash":30.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine (diagnostic) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457085620","type":"NDC"}],"standard_charges":[{"gross_charge":271.78,"discounted_cash":67.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine (diagnostic) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"17478054420","type":"NDC"}],"standard_charges":[{"gross_charge":222.6,"discounted_cash":55.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"adenosine (diagnostic) per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"703877601","type":"NDC"}],"standard_charges":[{"gross_charge":809.51,"discounted_cash":202.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexrazoxane per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1190","type":"HCPCS"},{"code":"72266010101","type":"NDC"}],"standard_charges":[{"gross_charge":968.68,"discounted_cash":242.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexrazoxane per 250 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1190","type":"HCPCS"},{"code":"72205024701","type":"NDC"}],"standard_charges":[{"gross_charge":415.33,"discounted_cash":103.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine in 5 % dextrose (PF) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"264959420","type":"NDC"}],"standard_charges":[{"gross_charge":55.54,"discounted_cash":13.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine in 5 % dextrose per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"409780911","type":"NDC"}],"standard_charges":[{"gross_charge":59.37,"discounted_cash":14.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine in 5 % dextrose per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"97710504303","type":"NDC"}],"standard_charges":[{"gross_charge":42.13,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine in 5 % dextrose per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"338100702","type":"NDC"}],"standard_charges":[{"gross_charge":82.35,"discounted_cash":20.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPamine in 5 % dextrose per 40 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"409780922","type":"NDC"}],"standard_charges":[{"gross_charge":59.37,"discounted_cash":14.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676032000","type":"NDC"}],"standard_charges":[{"gross_charge":3649.91,"discounted_cash":912.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"epoetin alfa per 1000 units (J0885) or 100 units (Q4081)","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676032004","type":"NDC"}],"standard_charges":[{"gross_charge":3649.91,"discounted_cash":912.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567070625","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceFAZolin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"143992490","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vinorelbine per","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9390","type":"HCPCS"},{"code":"25021020401","type":"NDC"}],"standard_charges":[{"gross_charge":97.89,"discounted_cash":24.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pamidronate 90 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"59923060310","type":"NDC"}],"standard_charges":[{"gross_charge":380.7,"discounted_cash":95.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide acetate per 25 mcg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"67457024600","type":"NDC"}],"standard_charges":[{"gross_charge":29.36,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide acetate per 25 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"67457023900","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323031161","type":"NDC"}],"standard_charges":[{"gross_charge":67.41,"discounted_cash":16.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323031150","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323031110","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"80830167202","type":"NDC"}],"standard_charges":[{"gross_charge":16.51,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"80830167201","type":"NDC"}],"standard_charges":[{"gross_charge":16.51,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"143918025","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"143918001","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036061","type":"NDC"}],"standard_charges":[{"gross_charge":20.68,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036059","type":"NDC"}],"standard_charges":[{"gross_charge":20.68,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"gross_charge":38.38,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036005","type":"NDC"}],"standard_charges":[{"gross_charge":20.68,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036003","type":"NDC"}],"standard_charges":[{"gross_charge":20.68,"discounted_cash":5.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"calcium gluconate per 10 mL","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036001","type":"NDC"}],"standard_charges":[{"gross_charge":38.38,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide acetate per 25 mcg","drug_information":{"unit":0.5,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"67457024500","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75 mg (J1950) or 7.5mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"74364203","type":"NDC"}],"standard_charges":[{"gross_charge":980.48,"discounted_cash":245.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydramine-0.9 % sod.chlr 25 mg/50 mL piggyback 50 mL Bag","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"97710509601","type":"NDC"}],"standard_charges":[{"gross_charge":29.11,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydramine-0.9 % sod.chlr 25 mg/50 mL piggyback 50 mL Bag","drug_information":{"unit":2.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"71285708901","type":"NDC"}],"standard_charges":[{"gross_charge":90.39,"discounted_cash":22.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75mg (J1950) or 7.5mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"74364103","type":"NDC"}],"standard_charges":[{"gross_charge":12823.84,"discounted_cash":3205.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vedolizumab per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3380","type":"HCPCS"},{"code":"64764030020","type":"NDC"}],"standard_charges":[{"gross_charge":71517.67,"discounted_cash":17879.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409000125","type":"NDC"}],"standard_charges":[{"gross_charge":16.44,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409000101","type":"NDC"}],"standard_charges":[{"gross_charge":16.44,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70069081610","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70069081601","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409230516","type":"NDC"}],"standard_charges":[{"gross_charge":5.01,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin calcium per 50 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323063150","type":"NDC"}],"standard_charges":[{"gross_charge":436.62,"discounted_cash":109.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409230517","type":"NDC"}],"standard_charges":[{"gross_charge":5.01,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409230821","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409230822","type":"NDC"}],"standard_charges":[{"gross_charge":7.03,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF 5 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"25021065601","type":"NDC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409230802","type":"NDC"}],"standard_charges":[{"gross_charge":7.03,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF 5 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409230801","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydramine-0.9 % sod.chlr 50 mg/50 mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"71285709001","type":"NDC"}],"standard_charges":[{"gross_charge":109.92,"discounted_cash":27.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diphenhydramine-0.9 % sod.chlr 50 mg/50 mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"99710509701","type":"NDC"}],"standard_charges":[{"gross_charge":14.55,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"409230505","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021047401","type":"NDC"}],"standard_charges":[{"gross_charge":17.77,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leucovorin per 50 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021081567","type":"NDC"}],"standard_charges":[{"gross_charge":74.84,"discounted_cash":18.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"heparin (porcine) in 5 % dex per 1000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"97710505104","type":"NDC"}],"standard_charges":[{"gross_charge":42.13,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"71288000920","type":"NDC"}],"standard_charges":[{"gross_charge":80.61,"discounted_cash":20.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"63323034021","type":"NDC"}],"standard_charges":[{"gross_charge":158.49,"discounted_cash":39.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"60505614700","type":"NDC"}],"standard_charges":[{"gross_charge":70.09,"discounted_cash":17.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021012267","type":"NDC"}],"standard_charges":[{"gross_charge":63.53,"discounted_cash":15.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"44567024110","type":"NDC"}],"standard_charges":[{"gross_charge":34.65,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"409022001","type":"NDC"}],"standard_charges":[{"gross_charge":69.18,"discounted_cash":17.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"gross_charge":56.8,"discounted_cash":14.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"60505068104","type":"NDC"}],"standard_charges":[{"gross_charge":136.54,"discounted_cash":34.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"44567013010","type":"NDC"}],"standard_charges":[{"gross_charge":18.31,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"409956610","type":"NDC"}],"standard_charges":[{"gross_charge":25.38,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"409956601","type":"NDC"}],"standard_charges":[{"gross_charge":25.38,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"409021911","type":"NDC"}],"standard_charges":[{"gross_charge":33.78,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021012166","type":"NDC"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"gross_charge":18.59,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"409021901","type":"NDC"}],"standard_charges":[{"gross_charge":33.78,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"66794021002","type":"NDC"}],"standard_charges":[{"gross_charge":158.49,"discounted_cash":39.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"63323032620","type":"NDC"}],"standard_charges":[{"gross_charge":73.16,"discounted_cash":18.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"66794021041","type":"NDC"}],"standard_charges":[{"gross_charge":158.49,"discounted_cash":39.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"409973510","type":"NDC"}],"standard_charges":[{"gross_charge":44.95,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"43598091411","type":"NDC"}],"standard_charges":[{"gross_charge":21.01,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65219003901","type":"NDC"}],"standard_charges":[{"gross_charge":49.97,"discounted_cash":12.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65219003900","type":"NDC"}],"standard_charges":[{"gross_charge":49.97,"discounted_cash":12.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323093001","type":"NDC"}],"standard_charges":[{"gross_charge":44.05,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323093000","type":"NDC"}],"standard_charges":[{"gross_charge":44.05,"discounted_cash":11.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70121164207","type":"NDC"}],"standard_charges":[{"gross_charge":25.3,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70121164201","type":"NDC"}],"standard_charges":[{"gross_charge":25.3,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150037125","type":"NDC"}],"standard_charges":[{"gross_charge":47.89,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150037101","type":"NDC"}],"standard_charges":[{"gross_charge":47.89,"discounted_cash":11.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"injection, vasopressin, 1 unit","drug_information":{"unit":0.25,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"42023016401","type":"NDC"}],"standard_charges":[{"gross_charge":956.75,"discounted_cash":239.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phenylephrine-ketorolac 1-0.3 % concentrate 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1097","type":"HCPCS"},{"code":"62225060004","type":"NDC"}],"standard_charges":[{"gross_charge":3561.9,"discounted_cash":890.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ferric citrate 210 mg iron tablet 200 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0609","type":"HCPCS"},{"code":"59922063101","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"44567013110","type":"NDC"}],"standard_charges":[{"gross_charge":34.13,"discounted_cash":8.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"70594009002","type":"NDC"}],"standard_charges":[{"gross_charge":55.35,"discounted_cash":13.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"70594009001","type":"NDC"}],"standard_charges":[{"gross_charge":55.35,"discounted_cash":13.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"409973501","type":"NDC"}],"standard_charges":[{"gross_charge":44.95,"discounted_cash":11.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cefepime per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0692","type":"HCPCS"},{"code":"25021012120","type":"NDC"}],"standard_charges":[{"gross_charge":31.67,"discounted_cash":7.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tedizolid 200 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3090","type":"HCPCS"},{"code":"67919004001","type":"NDC"}],"standard_charges":[{"gross_charge":2193.42,"discounted_cash":548.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule, for intramuscular use","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90620","type":"HCPCS"},{"code":"58160097602","type":"NDC"}],"standard_charges":[{"gross_charge":1291.49,"discounted_cash":322.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010826","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567041024","type":"NDC"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010801","type":"NDC"}],"standard_charges":[{"gross_charge":86.56,"discounted_cash":21.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409672723","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine in D5W per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"409234631","type":"NDC"}],"standard_charges":[{"gross_charge":45.96,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine in D5W per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"338107302","type":"NDC"}],"standard_charges":[{"gross_charge":61.28,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTamine in D5W per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"409234632","type":"NDC"}],"standard_charges":[{"gross_charge":45.96,"discounted_cash":11.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"409381511","type":"NDC"}],"standard_charges":[{"gross_charge":7.22,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"97710501601","type":"NDC"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":30.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":0.1,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"641601910","type":"NDC"}],"standard_charges":[{"gross_charge":14.77,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"641601901","type":"NDC"}],"standard_charges":[{"gross_charge":147.68,"discounted_cash":36.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"morphine PF per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2274","type":"HCPCS"},{"code":"409381512","type":"NDC"}],"standard_charges":[{"gross_charge":72.16,"discounted_cash":18.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010800","type":"NDC"}],"standard_charges":[{"gross_charge":86.56,"discounted_cash":21.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409672711","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457056700","type":"NDC"}],"standard_charges":[{"gross_charge":22.21,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010802","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule, for intramuscular use","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"90620","type":"HCPCS"},{"code":"46028011402","type":"NDC"}],"standard_charges":[{"gross_charge":933.06,"discounted_cash":233.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloPHOSphamide 25 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"62332061831","type":"NDC"}],"standard_charges":[{"gross_charge":6.59,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloPHOSphamide 25 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"54879002101","type":"NDC"}],"standard_charges":[{"gross_charge":20.62,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cycloPHOSphamide 25 mg capsule 100 each Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8530","type":"HCPCS"},{"code":"54038225","type":"NDC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide,microspheres 10 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"78081181","type":"NDC"}],"standard_charges":[{"gross_charge":25545.56,"discounted_cash":6386.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide,microspheres 10 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"78064681","type":"NDC"}],"standard_charges":[{"gross_charge":20007.23,"discounted_cash":5001.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide,microspheres 30 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"78082581","type":"NDC"}],"standard_charges":[{"gross_charge":50117.39,"discounted_cash":12529.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide,microspheres 30 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"78080461","type":"NDC"}],"standard_charges":[{"gross_charge":50117.39,"discounted_cash":12529.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide,microspheres 20 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"78079761","type":"NDC"}],"standard_charges":[{"gross_charge":33469.07,"discounted_cash":8367.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"peramivir (PF) solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2547","type":"HCPCS"},{"code":"61364018103","type":"NDC"}],"standard_charges":[{"gross_charge":2251.27,"discounted_cash":562.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"peramivir (PF) solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2547","type":"HCPCS"},{"code":"61364018101","type":"NDC"}],"standard_charges":[{"gross_charge":2251.27,"discounted_cash":562.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409672755","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"409672750","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"264440054","type":"NDC"}],"standard_charges":[{"gross_charge":25.28,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"magnesium sulfate in D5W per 500 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"338170940","type":"NDC"}],"standard_charges":[{"gross_charge":9.96,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"octreotide,microspheres 20 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2353","type":"HCPCS"},{"code":"78081881","type":"NDC"}],"standard_charges":[{"gross_charge":33469.07,"discounted_cash":8367.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0165","type":"HCPCS"},{"code":"54288015201","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0165","type":"HCPCS"},{"code":"42023016889","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0165","type":"HCPCS"},{"code":"76329906000","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457058400","type":"NDC"}],"standard_charges":[{"gross_charge":425.69,"discounted_cash":106.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111068011","type":"NDC"}],"standard_charges":[{"gross_charge":210.76,"discounted_cash":52.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111068002","type":"NDC"}],"standard_charges":[{"gross_charge":210.76,"discounted_cash":52.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"143938610","type":"NDC"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"143938601","type":"NDC"}],"standard_charges":[{"gross_charge":28.34,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"36000030660","type":"NDC"}],"standard_charges":[{"gross_charge":67.41,"discounted_cash":16.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"781927406","type":"NDC"}],"standard_charges":[{"gross_charge":56.68,"discounted_cash":14.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0136","type":"HCPCS"},{"code":"264410090","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0134","type":"HCPCS"},{"code":"63323043441","type":"NDC"}],"standard_charges":[{"gross_charge":115.67,"discounted_cash":28.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0134","type":"HCPCS"},{"code":"63323043400","type":"NDC"}],"standard_charges":[{"gross_charge":115.67,"discounted_cash":28.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"67457094010","type":"NDC"}],"standard_charges":[{"gross_charge":91.92,"discounted_cash":22.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"55150030724","type":"NDC"}],"standard_charges":[{"gross_charge":65.88,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"55150030701","type":"NDC"}],"standard_charges":[{"gross_charge":65.88,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"24201010024","type":"NDC"}],"standard_charges":[{"gross_charge":87.32,"discounted_cash":21.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"24201010001","type":"NDC"}],"standard_charges":[{"gross_charge":87.32,"discounted_cash":21.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457058406","type":"NDC"}],"standard_charges":[{"gross_charge":425.69,"discounted_cash":106.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"781315695","type":"NDC"}],"standard_charges":[{"gross_charge":29.87,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111068102","type":"NDC"}],"standard_charges":[{"gross_charge":210.77,"discounted_cash":52.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"67457058500","type":"NDC"}],"standard_charges":[{"gross_charge":425.69,"discounted_cash":106.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G benzathine per 100000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070102","type":"NDC"}],"standard_charges":[{"gross_charge":2432.17,"discounted_cash":608.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":17324.54,"discounted_cash":4331.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002801","type":"NDC"}],"standard_charges":[{"gross_charge":11549.67,"discounted_cash":2887.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002704","type":"NDC"}],"standard_charges":[{"gross_charge":8662.27,"discounted_cash":2165.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002701","type":"NDC"}],"standard_charges":[{"gross_charge":8662.27,"discounted_cash":2165.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002504","type":"NDC"}],"standard_charges":[{"gross_charge":5774.84,"discounted_cash":1443.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002501","type":"NDC"}],"standard_charges":[{"gross_charge":5774.84,"discounted_cash":1443.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002304","type":"NDC"}],"standard_charges":[{"gross_charge":3464.91,"discounted_cash":866.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002301","type":"NDC"}],"standard_charges":[{"gross_charge":3464.91,"discounted_cash":866.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002104","type":"NDC"}],"standard_charges":[{"gross_charge":2309.93,"discounted_cash":577.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002101","type":"NDC"}],"standard_charges":[{"gross_charge":2309.93,"discounted_cash":577.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0119,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513005704","type":"NDC"}],"standard_charges":[{"gross_charge":1460.91,"discounted_cash":365.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"darbepoetin alfa-polysorbate per 1 mcg","drug_information":{"unit":1.0119,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513005701","type":"NDC"}],"standard_charges":[{"gross_charge":1460.91,"discounted_cash":365.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150023310","type":"NDC"}],"standard_charges":[{"gross_charge":413.89,"discounted_cash":103.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150023300","type":"NDC"}],"standard_charges":[{"gross_charge":413.89,"discounted_cash":103.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fondaparinux per 0.5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111068111","type":"NDC"}],"standard_charges":[{"gross_charge":210.77,"discounted_cash":52.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaminophen per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"781315606","type":"NDC"}],"standard_charges":[{"gross_charge":29.87,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ceftaroline per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0712","type":"HCPCS"},{"code":"456060001","type":"NDC"}],"standard_charges":[{"gross_charge":1838.64,"discounted_cash":459.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"409423501","type":"NDC"}],"standard_charges":[{"gross_charge":97.13,"discounted_cash":24.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"143920401","type":"NDC"}],"standard_charges":[{"gross_charge":178.55,"discounted_cash":44.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"47335032340","type":"NDC"}],"standard_charges":[{"gross_charge":121.33,"discounted_cash":30.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"72485021401","type":"NDC"}],"standard_charges":[{"gross_charge":49.87,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"409036601","type":"NDC"}],"standard_charges":[{"gross_charge":209.73,"discounted_cash":52.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"43598025811","type":"NDC"}],"standard_charges":[{"gross_charge":181.47,"discounted_cash":45.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729026763","type":"NDC"}],"standard_charges":[{"gross_charge":201.69,"discounted_cash":50.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"955102001","type":"NDC"}],"standard_charges":[{"gross_charge":537.04,"discounted_cash":134.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049101","type":"NDC"}],"standard_charges":[{"gross_charge":104.94,"discounted_cash":26.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427816","type":"NDC"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323049157","type":"NDC"}],"standard_charges":[{"gross_charge":104.94,"discounted_cash":26.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"lidocaine PF per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409427801","type":"NDC"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"72266012401","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155055031","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155037731","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"47335032310","type":"NDC"}],"standard_charges":[{"gross_charge":138.34,"discounted_cash":34.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"70121122101","type":"NDC"}],"standard_charges":[{"gross_charge":126.85,"discounted_cash":31.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eriBULin per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"62856038901","type":"NDC"}],"standard_charges":[{"gross_charge":10773.64,"discounted_cash":2693.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eriBULin per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"81298389001","type":"NDC"}],"standard_charges":[{"gross_charge":4893.9,"discounted_cash":1223.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"denosumab per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"gross_charge":23333.89,"discounted_cash":5833.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.001,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"70860078310","type":"NDC"}],"standard_charges":[{"gross_charge":160.79,"discounted_cash":40.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"31722016531","type":"NDC"}],"standard_charges":[{"gross_charge":152.97,"discounted_cash":38.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"72205008301","type":"NDC"}],"standard_charges":[{"gross_charge":1401.7,"discounted_cash":350.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"55150029901","type":"NDC"}],"standard_charges":[{"gross_charge":137.04,"discounted_cash":34.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.001,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"143938401","type":"NDC"}],"standard_charges":[{"gross_charge":529.3,"discounted_cash":132.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"43598094811","type":"NDC"}],"standard_charges":[{"gross_charge":172.89,"discounted_cash":43.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G benzathine per 100000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070204","type":"NDC"}],"standard_charges":[{"gross_charge":4984.12,"discounted_cash":1246.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"72205005401","type":"NDC"}],"standard_charges":[{"gross_charge":117.96,"discounted_cash":29.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"338000801","type":"NDC"}],"standard_charges":[{"gross_charge":142.55,"discounted_cash":35.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"71839010401","type":"NDC"}],"standard_charges":[{"gross_charge":120.72,"discounted_cash":30.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"6306103","type":"NDC"}],"standard_charges":[{"gross_charge":575.88,"discounted_cash":143.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"6306102","type":"NDC"}],"standard_charges":[{"gross_charge":575.88,"discounted_cash":143.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"6306101","type":"NDC"}],"standard_charges":[{"gross_charge":2425.77,"discounted_cash":606.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"6306100","type":"NDC"}],"standard_charges":[{"gross_charge":2425.77,"discounted_cash":606.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"eriBULin per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"143916701","type":"NDC"}],"standard_charges":[{"gross_charge":3398.05,"discounted_cash":849.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fosaprepitant per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"69097083037","type":"NDC"}],"standard_charges":[{"gross_charge":431.03,"discounted_cash":107.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"409475901","type":"NDC"}],"standard_charges":[{"gross_charge":0.45,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G procaine-penicillin G benzathine per 100000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"60793060010","type":"NDC"}],"standard_charges":[{"gross_charge":1762.47,"discounted_cash":440.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G procaine-penicillin G benzathine per 100000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"60793060102","type":"NDC"}],"standard_charges":[{"gross_charge":1762.44,"discounted_cash":440.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013283","type":"NDC"}],"standard_charges":[{"gross_charge":43.66,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"409333024","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"409333001","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000029524","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":4.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"409052823","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043624","type":"NDC"}],"standard_charges":[{"gross_charge":117.2,"discounted_cash":29.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000004724","type":"NDC"}],"standard_charges":[{"gross_charge":17.62,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013267","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"143972101","type":"NDC"}],"standard_charges":[{"gross_charge":13.79,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013282","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":9.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"97710523001","type":"NDC"}],"standard_charges":[{"gross_charge":6.89,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"409222024","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"409222001","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000029424","type":"NDC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043524","type":"NDC"}],"standard_charges":[{"gross_charge":83.11,"discounted_cash":20.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"143972001","type":"NDC"}],"standard_charges":[{"gross_charge":44.81,"discounted_cash":11.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000004624","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013268","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043724","type":"NDC"}],"standard_charges":[{"gross_charge":121.79,"discounted_cash":30.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"23155090431","type":"NDC"}],"standard_charges":[{"gross_charge":280.75,"discounted_cash":70.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"409506801","type":"NDC"}],"standard_charges":[{"gross_charge":2117.16,"discounted_cash":529.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"25021024504","type":"NDC"}],"standard_charges":[{"gross_charge":296.44,"discounted_cash":74.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"39822218001","type":"NDC"}],"standard_charges":[{"gross_charge":580.26,"discounted_cash":145.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"409036701","type":"NDC"}],"standard_charges":[{"gross_charge":798.57,"discounted_cash":199.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729026764","type":"NDC"}],"standard_charges":[{"gross_charge":685.66,"discounted_cash":171.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"955102104","type":"NDC"}],"standard_charges":[{"gross_charge":4065.16,"discounted_cash":1016.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam-D5W per 1.125 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"338963801","type":"NDC"}],"standard_charges":[{"gross_charge":89.62,"discounted_cash":22.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"piperacillin-tazobactam-D5W per 1.125 g","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"206886201","type":"NDC"}],"standard_charges":[{"gross_charge":194.56,"discounted_cash":48.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"409444424","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"409444401","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000029624","type":"NDC"}],"standard_charges":[{"gross_charge":17.24,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"409052835","type":"NDC"}],"standard_charges":[{"gross_charge":13.79,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"409052831","type":"NDC"}],"standard_charges":[{"gross_charge":13.79,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"36000004824","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013266","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"143972224","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"143972201","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9393","type":"HCPCS"},{"code":"591501902","type":"NDC"}],"standard_charges":[{"gross_charge":570.4,"discounted_cash":142.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"25021046274","type":"NDC"}],"standard_charges":[{"gross_charge":762.86,"discounted_cash":190.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"781307912","type":"NDC"}],"standard_charges":[{"gross_charge":7426.45,"discounted_cash":1856.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"781307901","type":"NDC"}],"standard_charges":[{"gross_charge":7426.45,"discounted_cash":1856.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"310072010","type":"NDC"}],"standard_charges":[{"gross_charge":7240.88,"discounted_cash":1810.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"filgrastim per 1 mcg, excludes biosimilars","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513092401","type":"NDC"}],"standard_charges":[{"gross_charge":2489.78,"discounted_cash":622.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"cetuximab per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733095823","type":"NDC"}],"standard_charges":[{"gross_charge":12130.38,"discounted_cash":3032.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bevacizumab per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006101","type":"NDC"}],"standard_charges":[{"gross_charge":24357.21,"discounted_cash":6089.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bevacizumab 25 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006001","type":"NDC"}],"standard_charges":[{"gross_charge":6089.33,"discounted_cash":1522.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tocilizumab 400 mg/20 mL solution 20 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"gross_charge":20292.72,"discounted_cash":5073.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tocilizumab 200 mg/10 mL (20 mg/mL) solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013601","type":"NDC"}],"standard_charges":[{"gross_charge":10146.36,"discounted_cash":2536.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tocilizumab 80 mg/4 mL (20 mg/mL) solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013501","type":"NDC"}],"standard_charges":[{"gross_charge":4058.51,"discounted_cash":1014.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"panitumumab per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095601","type":"NDC"}],"standard_charges":[{"gross_charge":54115.91,"discounted_cash":13528.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"panitumumab per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095401","type":"NDC"}],"standard_charges":[{"gross_charge":13528.94,"discounted_cash":3382.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G procaine-penicillin G benzathine per 100000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"60793060002","type":"NDC"}],"standard_charges":[{"gross_charge":1762.47,"discounted_cash":440.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9393","type":"HCPCS"},{"code":"591501911","type":"NDC"}],"standard_charges":[{"gross_charge":570.4,"discounted_cash":142.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"67457031100","type":"NDC"}],"standard_charges":[{"gross_charge":1085.81,"discounted_cash":271.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"67457031105","type":"NDC"}],"standard_charges":[{"gross_charge":1085.81,"discounted_cash":271.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"68462031732","type":"NDC"}],"standard_charges":[{"gross_charge":926.78,"discounted_cash":231.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levofloxacin per 250 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013281","type":"NDC"}],"standard_charges":[{"gross_charge":29.11,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"paliperidone palmitate per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458056401","type":"NDC"}],"standard_charges":[{"gross_charge":23424.58,"discounted_cash":5856.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"paliperidone palmitate 39 mg/0.25 mL syringe 0.25 mL Syringe","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458056001","type":"NDC"}],"standard_charges":[{"gross_charge":3903.84,"discounted_cash":975.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"25021047174","type":"NDC"}],"standard_charges":[{"gross_charge":413.87,"discounted_cash":103.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"83634020374","type":"NDC"}],"standard_charges":[{"gross_charge":422.18,"discounted_cash":105.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"83634020341","type":"NDC"}],"standard_charges":[{"gross_charge":422.18,"discounted_cash":105.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"55150039402","type":"NDC"}],"standard_charges":[{"gross_charge":335.81,"discounted_cash":83.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"penicillin G procaine-penicillin G benzathine per 100000 Units","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0558","type":"HCPCS"},{"code":"60793060110","type":"NDC"}],"standard_charges":[{"gross_charge":1762.44,"discounted_cash":440.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"55150039401","type":"NDC"}],"standard_charges":[{"gross_charge":335.81,"discounted_cash":83.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"143902202","type":"NDC"}],"standard_charges":[{"gross_charge":259.02,"discounted_cash":64.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"143902201","type":"NDC"}],"standard_charges":[{"gross_charge":259.02,"discounted_cash":64.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"16729043631","type":"NDC"}],"standard_charges":[{"gross_charge":982.55,"discounted_cash":245.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"16729043630","type":"NDC"}],"standard_charges":[{"gross_charge":982.55,"discounted_cash":245.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"43598026211","type":"NDC"}],"standard_charges":[{"gross_charge":269.59,"discounted_cash":67.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"43598026202","type":"NDC"}],"standard_charges":[{"gross_charge":374.8,"discounted_cash":93.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"71288055586","type":"NDC"}],"standard_charges":[{"gross_charge":864.35,"discounted_cash":216.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"fulvestrant per 25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"70700028498","type":"NDC"}],"standard_charges":[{"gross_charge":469.6,"discounted_cash":117.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"781323909","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"143989001","type":"NDC"}],"standard_charges":[{"gross_charge":3.46,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"72266012301","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75802001","type":"NDC"}],"standard_charges":[{"gross_charge":61.04,"discounted_cash":15.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955101010","type":"NDC"}],"standard_charges":[{"gross_charge":152.23,"discounted_cash":38.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75062280","type":"NDC"}],"standard_charges":[{"gross_charge":141.85,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043587","type":"NDC"}],"standard_charges":[{"gross_charge":33.21,"discounted_cash":8.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043586","type":"NDC"}],"standard_charges":[{"gross_charge":33.21,"discounted_cash":8.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011210","type":"NDC"}],"standard_charges":[{"gross_charge":32.63,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043592","type":"NDC"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043591","type":"NDC"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"781326268","type":"NDC"}],"standard_charges":[{"gross_charge":39.88,"discounted_cash":9.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"781326204","type":"NDC"}],"standard_charges":[{"gross_charge":39.88,"discounted_cash":9.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955100801","type":"NDC"}],"standard_charges":[{"gross_charge":121.76,"discounted_cash":30.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75062201","type":"NDC"}],"standard_charges":[{"gross_charge":141.85,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041087","type":"NDC"}],"standard_charges":[{"gross_charge":38.38,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041086","type":"NDC"}],"standard_charges":[{"gross_charge":38.38,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75801801","type":"NDC"}],"standard_charges":[{"gross_charge":46.98,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"60505079501","type":"NDC"}],"standard_charges":[{"gross_charge":106.86,"discounted_cash":26.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955100810","type":"NDC"}],"standard_charges":[{"gross_charge":121.76,"discounted_cash":30.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"60505079504","type":"NDC"}],"standard_charges":[{"gross_charge":106.86,"discounted_cash":26.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041089","type":"NDC"}],"standard_charges":[{"gross_charge":40.9,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75291200","type":"NDC"}],"standard_charges":[{"gross_charge":116.39,"discounted_cash":29.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955101201","type":"NDC"}],"standard_charges":[{"gross_charge":100.14,"discounted_cash":25.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041181","type":"NDC"}],"standard_charges":[{"gross_charge":26.93,"discounted_cash":6.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041180","type":"NDC"}],"standard_charges":[{"gross_charge":26.93,"discounted_cash":6.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75802201","type":"NDC"}],"standard_charges":[{"gross_charge":39.14,"discounted_cash":9.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955101210","type":"NDC"}],"standard_charges":[{"gross_charge":100.14,"discounted_cash":25.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75062300","type":"NDC"}],"standard_charges":[{"gross_charge":177.31,"discounted_cash":44.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043692","type":"NDC"}],"standard_charges":[{"gross_charge":40.9,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043691","type":"NDC"}],"standard_charges":[{"gross_charge":40.9,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"781326869","type":"NDC"}],"standard_charges":[{"gross_charge":54.38,"discounted_cash":13.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"781326805","type":"NDC"}],"standard_charges":[{"gross_charge":54.38,"discounted_cash":13.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001046143","type":"NDC"}],"standard_charges":[{"gross_charge":126.39,"discounted_cash":31.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001046142","type":"NDC"}],"standard_charges":[{"gross_charge":126.39,"discounted_cash":31.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955101001","type":"NDC"}],"standard_charges":[{"gross_charge":152.23,"discounted_cash":38.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75062303","type":"NDC"}],"standard_charges":[{"gross_charge":177.31,"discounted_cash":44.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041088","type":"NDC"}],"standard_charges":[{"gross_charge":40.9,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"548560400","type":"NDC"}],"standard_charges":[{"gross_charge":87.32,"discounted_cash":21.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75062160","type":"NDC"}],"standard_charges":[{"gross_charge":106.39,"discounted_cash":26.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043485","type":"NDC"}],"standard_charges":[{"gross_charge":24.07,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"60505079204","type":"NDC"}],"standard_charges":[{"gross_charge":42.74,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"60505079200","type":"NDC"}],"standard_charges":[{"gross_charge":42.74,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323056887","type":"NDC"}],"standard_charges":[{"gross_charge":69.94,"discounted_cash":17.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75801401","type":"NDC"}],"standard_charges":[{"gross_charge":23.76,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955100410","type":"NDC"}],"standard_charges":[{"gross_charge":60.83,"discounted_cash":15.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"781322464","type":"NDC"}],"standard_charges":[{"gross_charge":23.82,"discounted_cash":5.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"781322402","type":"NDC"}],"standard_charges":[{"gross_charge":23.82,"discounted_cash":5.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"548560200","type":"NDC"}],"standard_charges":[{"gross_charge":43.66,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75062430","type":"NDC"}],"standard_charges":[{"gross_charge":53.13,"discounted_cash":13.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043292","type":"NDC"}],"standard_charges":[{"gross_charge":12.99,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043291","type":"NDC"}],"standard_charges":[{"gross_charge":12.99,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043281","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043280","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041081","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041080","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041082","type":"NDC"}],"standard_charges":[{"gross_charge":19.23,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041083","type":"NDC"}],"standard_charges":[{"gross_charge":19.23,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75062001","type":"NDC"}],"standard_charges":[{"gross_charge":70.84,"discounted_cash":17.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955100401","type":"NDC"}],"standard_charges":[{"gross_charge":60.83,"discounted_cash":15.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043484","type":"NDC"}],"standard_charges":[{"gross_charge":24.07,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043492","type":"NDC"}],"standard_charges":[{"gross_charge":23.7,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043491","type":"NDC"}],"standard_charges":[{"gross_charge":23.7,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955100601","type":"NDC"}],"standard_charges":[{"gross_charge":91.35,"discounted_cash":22.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75062101","type":"NDC"}],"standard_charges":[{"gross_charge":106.1,"discounted_cash":26.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041085","type":"NDC"}],"standard_charges":[{"gross_charge":27.84,"discounted_cash":6.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288041084","type":"NDC"}],"standard_charges":[{"gross_charge":27.84,"discounted_cash":6.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"781329804","type":"NDC"}],"standard_charges":[{"gross_charge":34.59,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75801601","type":"NDC"}],"standard_charges":[{"gross_charge":36.72,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75062040","type":"NDC"}],"standard_charges":[{"gross_charge":70.84,"discounted_cash":17.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043392","type":"NDC"}],"standard_charges":[{"gross_charge":16.42,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043391","type":"NDC"}],"standard_charges":[{"gross_charge":16.42,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043383","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043382","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"781324664","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"781324602","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"955100610","type":"NDC"}],"standard_charges":[{"gross_charge":91.35,"discounted_cash":22.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"72266012325","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043793","type":"NDC"}],"standard_charges":[{"gross_charge":26.93,"discounted_cash":6.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"75291201","type":"NDC"}],"standard_charges":[{"gross_charge":116.7,"discounted_cash":29.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"409475503","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"63323037302","type":"NDC"}],"standard_charges":[{"gross_charge":19.82,"discounted_cash":4.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"25021025020","type":"NDC"}],"standard_charges":[{"gross_charge":402.38,"discounted_cash":100.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"72819015205","type":"NDC"}],"standard_charges":[{"gross_charge":356.04,"discounted_cash":89.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"71288013720","type":"NDC"}],"standard_charges":[{"gross_charge":944.94,"discounted_cash":236.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"67457051805","type":"NDC"}],"standard_charges":[{"gross_charge":6681.74,"discounted_cash":1670.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"16729011505","type":"NDC"}],"standard_charges":[{"gross_charge":634.94,"discounted_cash":158.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"25021025251","type":"NDC"}],"standard_charges":[{"gross_charge":749.3,"discounted_cash":187.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"25021025150","type":"NDC"}],"standard_charges":[{"gross_charge":358.56,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"36000001225","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"67457099620","type":"NDC"}],"standard_charges":[{"gross_charge":5567.13,"discounted_cash":1391.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"641607801","type":"NDC"}],"standard_charges":[{"gross_charge":28.05,"discounted_cash":7.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155019631","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"16729029783","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"16729029730","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"60505613005","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"60505613000","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054831","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054731","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054842","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054742","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"409475518","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"67457044022","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"67457044000","type":"NDC"}],"standard_charges":[{"gross_charge":3.71,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155037842","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155037841","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155037831","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"55150012502","type":"NDC"}],"standard_charges":[{"gross_charge":8.82,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ondansetron per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"25021077702","type":"NDC"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"67457051920","type":"NDC"}],"standard_charges":[{"gross_charge":9791.85,"discounted_cash":2447.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitomycin per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"16729010811","type":"NDC"}],"standard_charges":[{"gross_charge":510.08,"discounted_cash":127.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"43598010611","type":"NDC"}],"standard_charges":[{"gross_charge":103.43,"discounted_cash":25.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041218","type":"NDC"}],"standard_charges":[{"gross_charge":30.46,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041213","type":"NDC"}],"standard_charges":[{"gross_charge":99.12,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041203","type":"NDC"}],"standard_charges":[{"gross_charge":60.09,"discounted_cash":15.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641621110","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641621101","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70860060110","type":"NDC"}],"standard_charges":[{"gross_charge":16.39,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155060142","type":"NDC"}],"standard_charges":[{"gross_charge":31.18,"discounted_cash":7.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155060132","type":"NDC"}],"standard_charges":[{"gross_charge":31.18,"discounted_cash":7.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155060131","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641606301","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam 5 mg/mL solution 1 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641606101","type":"NDC"}],"standard_charges":[{"gross_charge":4.28,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641606010","type":"NDC"}],"standard_charges":[{"gross_charge":63.42,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"641606001","type":"NDC"}],"standard_charges":[{"gross_charge":63.42,"discounted_cash":15.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"17478052410","type":"NDC"}],"standard_charges":[{"gross_charge":46.42,"discounted_cash":11.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041225","type":"NDC"}],"standard_charges":[{"gross_charge":30.46,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041202","type":"NDC"}],"standard_charges":[{"gross_charge":60.09,"discounted_cash":15.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"midazolam per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041210","type":"NDC"}],"standard_charges":[{"gross_charge":99.12,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minocycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2265","type":"HCPCS"},{"code":"65293001401","type":"NDC"}],"standard_charges":[{"gross_charge":1095.87,"discounted_cash":273.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minocycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2265","type":"HCPCS"},{"code":"65293001410","type":"NDC"}],"standard_charges":[{"gross_charge":1095.87,"discounted_cash":273.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"43598010610","type":"NDC"}],"standard_charges":[{"gross_charge":103.43,"discounted_cash":25.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"76045020420","type":"NDC"}],"standard_charges":[{"gross_charge":190.32,"discounted_cash":47.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"76045020400","type":"NDC"}],"standard_charges":[{"gross_charge":190.32,"discounted_cash":47.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"641624410","type":"NDC"}],"standard_charges":[{"gross_charge":211.68,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"641624401","type":"NDC"}],"standard_charges":[{"gross_charge":211.68,"discounted_cash":52.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339013634","type":"NDC"}],"standard_charges":[{"gross_charge":105.68,"discounted_cash":26.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339013603","type":"NDC"}],"standard_charges":[{"gross_charge":105.68,"discounted_cash":26.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"enoxaparin per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011510","type":"NDC"}],"standard_charges":[{"gross_charge":26.99,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339013632","type":"NDC"}],"standard_charges":[{"gross_charge":125.26,"discounted_cash":31.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"97710510801","type":"NDC"}],"standard_charges":[{"gross_charge":44.83,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"409127303","type":"NDC"}],"standard_charges":[{"gross_charge":228.61,"discounted_cash":57.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"409127332","type":"NDC"}],"standard_charges":[{"gross_charge":228.61,"discounted_cash":57.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Hexaminolevulinate inj 100 mg, per study dose","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9589","type":"HCPCS"},{"code":"10511300102","type":"NDC"}],"standard_charges":[{"gross_charge":10341.0,"discounted_cash":2585.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Hexaminolevulinate inj 100 mg, per study dose","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"A9589","type":"HCPCS"},{"code":"10511300101","type":"NDC"}],"standard_charges":[{"gross_charge":7468.5,"discounted_cash":1867.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minocycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2265","type":"HCPCS"},{"code":"70842016010","type":"NDC"}],"standard_charges":[{"gross_charge":1975.16,"discounted_cash":493.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"minocycline 100 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2265","type":"HCPCS"},{"code":"70842016001","type":"NDC"}],"standard_charges":[{"gross_charge":1975.16,"discounted_cash":493.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"diazepam per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339013602","type":"NDC"}],"standard_charges":[{"gross_charge":125.26,"discounted_cash":31.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"bevacizumab-awwb 25 mg/mL solution 4 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020601","type":"NDC"}],"standard_charges":[{"gross_charge":3309.43,"discounted_cash":827.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"409230001","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":4.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"mitoMYcin per 0.2 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7315","type":"HCPCS"},{"code":"49771000201","type":"NDC"}],"standard_charges":[{"gross_charge":3293.8,"discounted_cash":823.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ofatumumab per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9302","type":"HCPCS"},{"code":"173082101","type":"NDC"}],"standard_charges":[{"gross_charge":36034.56,"discounted_cash":9008.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"triamcinolone acetonide per 10 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"3049420","type":"NDC"}],"standard_charges":[{"gross_charge":18.48,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"83634040141","type":"NDC"}],"standard_charges":[{"gross_charge":32.63,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021041510","type":"NDC"}],"standard_charges":[{"gross_charge":14.48,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"81284061110","type":"NDC"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"81284061100","type":"NDC"}],"standard_charges":[{"gross_charge":16.7,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72485010710","type":"NDC"}],"standard_charges":[{"gross_charge":31.79,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"72485010701","type":"NDC"}],"standard_charges":[{"gross_charge":31.79,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"60505616901","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"60505616900","type":"NDC"}],"standard_charges":[{"gross_charge":45.5,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"61990061102","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"61990061100","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"23155052431","type":"NDC"}],"standard_charges":[{"gross_charge":34.93,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"23155016631","type":"NDC"}],"standard_charges":[{"gross_charge":52.47,"discounted_cash":13.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457034210","type":"NDC"}],"standard_charges":[{"gross_charge":82.11,"discounted_cash":20.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150018810","type":"NDC"}],"standard_charges":[{"gross_charge":17.24,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021015899","type":"NDC"}],"standard_charges":[{"gross_charge":197.53,"discounted_cash":49.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"143916401","type":"NDC"}],"standard_charges":[{"gross_charge":140.15,"discounted_cash":35.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478054005","type":"NDC"}],"standard_charges":[{"gross_charge":42.74,"discounted_cash":10.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478054001","type":"NDC"}],"standard_charges":[{"gross_charge":18.03,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409263450","type":"NDC"}],"standard_charges":[{"gross_charge":887.79,"discounted_cash":221.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.04,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409263405","type":"NDC"}],"standard_charges":[{"gross_charge":82.09,"discounted_cash":20.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409263401","type":"NDC"}],"standard_charges":[{"gross_charge":70.39,"discounted_cash":17.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pertuzumab per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9306","type":"HCPCS"},{"code":"50242014501","type":"NDC"}],"standard_charges":[{"gross_charge":52114.35,"discounted_cash":13028.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050600","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050641","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150030425","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150030401","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":25.78,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069002101","type":"NDC"}],"standard_charges":[{"gross_charge":25.78,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"dexamethasone per 0.25 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050616","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323031461","type":"NDC"}],"standard_charges":[{"gross_charge":892.54,"discounted_cash":223.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"vancomycin per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70436002382","type":"NDC"}],"standard_charges":[{"gross_charge":87.07,"discounted_cash":21.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517096001","type":"NDC"}],"standard_charges":[{"gross_charge":53.47,"discounted_cash":13.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"13111421","type":"NDC"}],"standard_charges":[{"gross_charge":31.94,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"13111420","type":"NDC"}],"standard_charges":[{"gross_charge":31.94,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"39822019001","type":"NDC"}],"standard_charges":[{"gross_charge":87.02,"discounted_cash":21.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sincalide per 5 mcg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2805","type":"HCPCS"},{"code":"72266024801","type":"NDC"}],"standard_charges":[{"gross_charge":601.4,"discounted_cash":150.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sincalide per 5 mcg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2805","type":"HCPCS"},{"code":"270055615","type":"NDC"}],"standard_charges":[{"gross_charge":964.8,"discounted_cash":241.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"1439283001","type":"NDC"}],"standard_charges":[{"gross_charge":92.69,"discounted_cash":23.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"1439283010","type":"NDC"}],"standard_charges":[{"gross_charge":92.69,"discounted_cash":23.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"65145017510","type":"NDC"}],"standard_charges":[{"gross_charge":104.94,"discounted_cash":26.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"65145017501","type":"NDC"}],"standard_charges":[{"gross_charge":104.94,"discounted_cash":26.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050310","type":"NDC"}],"standard_charges":[{"gross_charge":136.35,"discounted_cash":34.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050301","type":"NDC"}],"standard_charges":[{"gross_charge":136.35,"discounted_cash":34.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"70860060441","type":"NDC"}],"standard_charges":[{"gross_charge":112.6,"discounted_cash":28.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"70860060482","type":"NDC"}],"standard_charges":[{"gross_charge":112.6,"discounted_cash":28.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598063752","type":"NDC"}],"standard_charges":[{"gross_charge":62.81,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598063710","type":"NDC"}],"standard_charges":[{"gross_charge":62.81,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150024847","type":"NDC"}],"standard_charges":[{"gross_charge":92.69,"discounted_cash":23.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in Sodium Chloride 1,500 mg/100 mL piggyback 100 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457026600","type":"NDC"}],"standard_charges":[{"gross_charge":112.6,"discounted_cash":28.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"39822019109","type":"NDC"}],"standard_charges":[{"gross_charge":88.63,"discounted_cash":22.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"143950301","type":"NDC"}],"standard_charges":[{"gross_charge":502.5,"discounted_cash":125.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"67457085350","type":"NDC"}],"standard_charges":[{"gross_charge":289.93,"discounted_cash":72.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"acetaZOLAMIDE per 500 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"23155031331","type":"NDC"}],"standard_charges":[{"gross_charge":282.81,"discounted_cash":70.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323056310","type":"NDC"}],"standard_charges":[{"gross_charge":87.71,"discounted_cash":21.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"67457019710","type":"NDC"}],"standard_charges":[{"gross_charge":56.53,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"67457019700","type":"NDC"}],"standard_charges":[{"gross_charge":56.53,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"13111410","type":"NDC"}],"standard_charges":[{"gross_charge":36.39,"discounted_cash":9.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517096010","type":"NDC"}],"standard_charges":[{"gross_charge":53.47,"discounted_cash":13.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tranexamic acid 1000 mg/10 mL solution 10 mL AMPUL","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"13111401","type":"NDC"}],"standard_charges":[{"gross_charge":24.05,"discounted_cash":6.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"39822041201","type":"NDC"}],"standard_charges":[{"gross_charge":398.78,"discounted_cash":99.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"17478054050","type":"NDC"}],"standard_charges":[{"gross_charge":505.94,"discounted_cash":126.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"70436011080","type":"NDC"}],"standard_charges":[{"gross_charge":308.39,"discounted_cash":77.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"72266016306","type":"NDC"}],"standard_charges":[{"gross_charge":302.78,"discounted_cash":75.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"72266016301","type":"NDC"}],"standard_charges":[{"gross_charge":302.78,"discounted_cash":75.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323030355","type":"NDC"}],"standard_charges":[{"gross_charge":639.59,"discounted_cash":159.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323030351","type":"NDC"}],"standard_charges":[{"gross_charge":761.94,"discounted_cash":190.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terbutaline per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"143974601","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terbutaline per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"143974610","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"terbutaline per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"gross_charge":184.1,"discounted_cash":46.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"tobramycin per 80 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"70436011036","type":"NDC"}],"standard_charges":[{"gross_charge":248.49,"discounted_cash":62.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050210","type":"NDC"}],"standard_charges":[{"gross_charge":99.58,"discounted_cash":24.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"703001801","type":"NDC"}],"standard_charges":[{"gross_charge":633.87,"discounted_cash":158.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"703011001","type":"NDC"}],"standard_charges":[{"gross_charge":23.47,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70700016525","type":"NDC"}],"standard_charges":[{"gross_charge":15.3,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70700016522","type":"NDC"}],"standard_charges":[{"gross_charge":15.3,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"781382975","type":"NDC"}],"standard_charges":[{"gross_charge":23.21,"discounted_cash":5.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"781382996","type":"NDC"}],"standard_charges":[{"gross_charge":23.21,"discounted_cash":5.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288040806","type":"NDC"}],"standard_charges":[{"gross_charge":52.82,"discounted_cash":13.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288040805","type":"NDC"}],"standard_charges":[{"gross_charge":52.82,"discounted_cash":13.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"66794020442","type":"NDC"}],"standard_charges":[{"gross_charge":18.08,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"66794020402","type":"NDC"}],"standard_charges":[{"gross_charge":18.08,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"55150029405","type":"NDC"}],"standard_charges":[{"gross_charge":59.67,"discounted_cash":14.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323057804","type":"NDC"}],"standard_charges":[{"gross_charge":129.9,"discounted_cash":32.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323057803","type":"NDC"}],"standard_charges":[{"gross_charge":73.82,"discounted_cash":18.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323057802","type":"NDC"}],"standard_charges":[{"gross_charge":129.9,"discounted_cash":32.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323057801","type":"NDC"}],"standard_charges":[{"gross_charge":73.82,"discounted_cash":18.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"36623057805","type":"NDC"}],"standard_charges":[{"gross_charge":88.7,"discounted_cash":22.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323057807","type":"NDC"}],"standard_charges":[{"gross_charge":279.44,"discounted_cash":69.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70700016722","type":"NDC"}],"standard_charges":[{"gross_charge":38.45,"discounted_cash":9.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70069001325","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70700016725","type":"NDC"}],"standard_charges":[{"gross_charge":38.45,"discounted_cash":9.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729047163","type":"NDC"}],"standard_charges":[{"gross_charge":66.27,"discounted_cash":16.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHrine per 0.1 mg","drug_information":{"unit":0.01,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0165","type":"HCPCS"},{"code":"42023016801","type":"NDC"}],"standard_charges":[{"gross_charge":12.33,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole ER 400 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0401","type":"HCPCS"},{"code":"59148001970","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole ER 400 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0401","type":"HCPCS"},{"code":"59148001971","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole ER 300 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0401","type":"HCPCS"},{"code":"59148001870","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPiprazole ER 300 mg suspension,extended rel recon 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0401","type":"HCPCS"},{"code":"59148001871","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ado-trastuzumab 160 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"50242008701","type":"NDC"}],"standard_charges":[{"gross_charge":48774.59,"discounted_cash":12193.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ado-trastuzumab emt inj, 1 MG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"50242008801","type":"NDC"}],"standard_charges":[{"gross_charge":30484.2,"discounted_cash":7621.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"haemophilus B polysac-tetanus toxoid (ActHIB) per 0.5 mL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90648","type":"HCPCS"},{"code":"49281054758","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288041492","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288041491","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288041506","type":"NDC"}],"standard_charges":[{"gross_charge":19.23,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288041505","type":"NDC"}],"standard_charges":[{"gross_charge":19.23,"discounted_cash":4.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288041403","type":"NDC"}],"standard_charges":[{"gross_charge":4.93,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288041401","type":"NDC"}],"standard_charges":[{"gross_charge":4.93,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71839012525","type":"NDC"}],"standard_charges":[{"gross_charge":26.7,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"16729047108","type":"NDC"}],"standard_charges":[{"gross_charge":66.27,"discounted_cash":16.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70069001301","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70121139605","type":"NDC"}],"standard_charges":[{"gross_charge":63.58,"discounted_cash":15.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70121139601","type":"NDC"}],"standard_charges":[{"gross_charge":63.58,"discounted_cash":15.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"703367801","type":"NDC"}],"standard_charges":[{"gross_charge":9.99,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"703367501","type":"NDC"}],"standard_charges":[{"gross_charge":5.81,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"61703040841","type":"NDC"}],"standard_charges":[{"gross_charge":13.7,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"47335093940","type":"NDC"}],"standard_charges":[{"gross_charge":618.01,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"67457078108","type":"NDC"}],"standard_charges":[{"gross_charge":1211.08,"discounted_cash":302.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCEtaxel per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729026765","type":"NDC"}],"standard_charges":[{"gross_charge":1371.2,"discounted_cash":342.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zidovudine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3485","type":"HCPCS"},{"code":"49702021326","type":"NDC"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":54.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zidovudine per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3485","type":"HCPCS"},{"code":"49702021301","type":"NDC"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":54.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.04,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409263425","type":"NDC"}],"standard_charges":[{"gross_charge":82.09,"discounted_cash":20.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409263410","type":"NDC"}],"standard_charges":[{"gross_charge":70.39,"discounted_cash":17.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323085150","type":"NDC"}],"standard_charges":[{"gross_charge":1232.88,"discounted_cash":308.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323085110","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323085107","type":"NDC"}],"standard_charges":[{"gross_charge":87.86,"discounted_cash":21.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"63323085103","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate PF per 5 mg","drug_information":{"unit":0.3,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"16729027730","type":"NDC"}],"standard_charges":[{"gross_charge":9.72,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"16729027735","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"methotrexate per 5 mg","drug_information":{"unit":0.05,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"703367881","type":"NDC"}],"standard_charges":[{"gross_charge":6.27,"discounted_cash":1.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70121139405","type":"NDC"}],"standard_charges":[{"gross_charge":42.78,"discounted_cash":10.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"70121139401","type":"NDC"}],"standard_charges":[{"gross_charge":42.78,"discounted_cash":10.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143968225","type":"NDC"}],"standard_charges":[{"gross_charge":68.17,"discounted_cash":17.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143968201","type":"NDC"}],"standard_charges":[{"gross_charge":68.17,"discounted_cash":17.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143968025","type":"NDC"}],"standard_charges":[{"gross_charge":275.42,"discounted_cash":68.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"143968001","type":"NDC"}],"standard_charges":[{"gross_charge":275.42,"discounted_cash":68.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517460525","type":"NDC"}],"standard_charges":[{"gross_charge":407.47,"discounted_cash":101.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROmorphone PF per 4 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"703011301","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":16.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, glycopyrrolate, 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"517460125","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"69097000396","type":"NDC"}],"standard_charges":[{"gross_charge":136.95,"discounted_cash":34.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"69097000367","type":"NDC"}],"standard_charges":[{"gross_charge":136.95,"discounted_cash":34.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"76329124001","type":"NDC"}],"standard_charges":[{"gross_charge":173.5,"discounted_cash":43.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziv-aflibercept per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9400","type":"HCPCS"},{"code":"24584101","type":"NDC"}],"standard_charges":[{"gross_charge":11949.6,"discounted_cash":2987.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ziv-aflibercept per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9400","type":"HCPCS"},{"code":"24584001","type":"NDC"}],"standard_charges":[{"gross_charge":5974.8,"discounted_cash":1493.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"carfilzomib per 1 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"76075010101","type":"NDC"}],"standard_charges":[{"gross_charge":27024.48,"discounted_cash":6756.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"omacetaxine 3.5 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9262","type":"HCPCS"},{"code":"63459017714","type":"NDC"}],"standard_charges":[{"gross_charge":9085.45,"discounted_cash":2271.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"781323946","type":"NDC"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050201","type":"NDC"}],"standard_charges":[{"gross_charge":99.58,"discounted_cash":24.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789022008","type":"NDC"}],"standard_charges":[{"gross_charge":164.69,"discounted_cash":41.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"97710511702","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338070948","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone per 30 mg","drug_information":{"unit":1.02,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066036020","type":"NDC"}],"standard_charges":[{"gross_charge":184.39,"discounted_cash":46.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone in dextrose,iso-osm per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"97710508502","type":"NDC"}],"standard_charges":[{"gross_charge":16.61,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amiodarone in dextrose,iso-osm per 30 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"43066015010","type":"NDC"}],"standard_charges":[{"gross_charge":153.97,"discounted_cash":38.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"65145015110","type":"NDC"}],"standard_charges":[{"gross_charge":85.63,"discounted_cash":21.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"65145015101","type":"NDC"}],"standard_charges":[{"gross_charge":85.63,"discounted_cash":21.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"69097070896","type":"NDC"}],"standard_charges":[{"gross_charge":32.63,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"69097070831","type":"NDC"}],"standard_charges":[{"gross_charge":32.63,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"409915850","type":"NDC"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"409915831","type":"NDC"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"gross_charge":20.76,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"43598040511","type":"NDC"}],"standard_charges":[{"gross_charge":20.76,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phytonadione per 1 mg","drug_information":{"unit":0.2,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"409915801","type":"NDC"}],"standard_charges":[{"gross_charge":60.9,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phentolamine per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"51224001210","type":"NDC"}],"standard_charges":[{"gross_charge":2498.69,"discounted_cash":624.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"990707426","type":"NDC"}],"standard_charges":[{"gross_charge":21.45,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phentolamine per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"51224001220","type":"NDC"}],"standard_charges":[{"gross_charge":2516.54,"discounted_cash":629.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789010916","type":"NDC"}],"standard_charges":[{"gross_charge":306.4,"discounted_cash":76.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride in water 10 mEq/50 mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338070541","type":"NDC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9% with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"97710506905","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9% with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323068610","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9% with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323068601","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9% with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"990711509","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9% with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338069104","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9% with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"264786500","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9% with KCl 20 mEq/L per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"409711509","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789010708","type":"NDC"}],"standard_charges":[{"gross_charge":181.93,"discounted_cash":45.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789010705","type":"NDC"}],"standard_charges":[{"gross_charge":181.93,"discounted_cash":45.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"990707714","type":"NDC"}],"standard_charges":[{"gross_charge":20.3,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"97710510901","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338070341","type":"NDC"}],"standard_charges":[{"gross_charge":24.51,"discounted_cash":6.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride per 2 mEq","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"409707714","type":"NDC"}],"standard_charges":[{"gross_charge":20.3,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"leuprolide per 3.75mg (J1950) or 7.5mg (J9217)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1950","type":"HCPCS"},{"code":"74347303","type":"NDC"}],"standard_charges":[{"gross_charge":5882.88,"discounted_cash":1470.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride in water 10 mEq/50 mL piggyback 50 mL Flex Cont","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"990707514","type":"NDC"}],"standard_charges":[{"gross_charge":20.3,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"potassium chloride in water 10 mEq/50 mL piggyback 50 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"409707514","type":"NDC"}],"standard_charges":[{"gross_charge":35.62,"discounted_cash":8.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phentolamine per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"68094010120","type":"NDC"}],"standard_charges":[{"gross_charge":2555.68,"discounted_cash":638.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"phentolamine per 5 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2760","type":"HCPCS"},{"code":"143956401","type":"NDC"}],"standard_charges":[{"gross_charge":6584.92,"discounted_cash":1646.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pentostatin per 10 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9268","type":"HCPCS"},{"code":"409080101","type":"NDC"}],"standard_charges":[{"gross_charge":18988.83,"discounted_cash":4747.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"703904003","type":"NDC"}],"standard_charges":[{"gross_charge":229.06,"discounted_cash":57.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021019287","type":"NDC"}],"standard_charges":[{"gross_charge":50.56,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"409330001","type":"NDC"}],"standard_charges":[{"gross_charge":21.45,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"781324048","type":"NDC"}],"standard_charges":[{"gross_charge":36.77,"discounted_cash":9.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"36000000924","type":"NDC"}],"standard_charges":[{"gross_charge":33.7,"discounted_cash":8.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021011487","type":"NDC"}],"standard_charges":[{"gross_charge":47.49,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"409477702","type":"NDC"}],"standard_charges":[{"gross_charge":21.45,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"25021017302","type":"NDC"}],"standard_charges":[{"gross_charge":33.2,"discounted_cash":8.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"63323081502","type":"NDC"}],"standard_charges":[{"gross_charge":151.35,"discounted_cash":37.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"641616710","type":"NDC"}],"standard_charges":[{"gross_charge":151.35,"discounted_cash":37.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"641616701","type":"NDC"}],"standard_charges":[{"gross_charge":151.35,"discounted_cash":37.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"gross_charge":35.82,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155029031","type":"NDC"}],"standard_charges":[{"gross_charge":35.82,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"703903201","type":"NDC"}],"standard_charges":[{"gross_charge":151.35,"discounted_cash":37.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ciprofloxacin per 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"409230024","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":4.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155029032","type":"NDC"}],"standard_charges":[{"gross_charge":59.1,"discounted_cash":14.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"amikacin per 100 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"63323081504","type":"NDC"}],"standard_charges":[{"gross_charge":217.76,"discounted_cash":54.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"9752905","type":"NDC"}],"standard_charges":[{"gross_charge":824.18,"discounted_cash":206.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"59923071615","type":"NDC"}],"standard_charges":[{"gross_charge":396.63,"discounted_cash":99.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrated per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"72485010401","type":"NDC"}],"standard_charges":[{"gross_charge":81.05,"discounted_cash":20.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrated per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"55150018703","type":"NDC"}],"standard_charges":[{"gross_charge":41.43,"discounted_cash":10.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrated per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"63323040704","type":"NDC"}],"standard_charges":[{"gross_charge":35.85,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrated per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"51754050001","type":"NDC"}],"standard_charges":[{"gross_charge":28.73,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrated per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"25021060103","type":"NDC"}],"standard_charges":[{"gross_charge":38.08,"discounted_cash":9.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrated per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"55390035703","type":"NDC"}],"standard_charges":[{"gross_charge":66.48,"discounted_cash":16.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrated per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"517002010","type":"NDC"}],"standard_charges":[{"gross_charge":34.93,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9% with KCl 40 mEq/L 40 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"338069504","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"caffeine citrated per 5 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J0706","type":"HCPCS"},{"code":"63323040703","type":"NDC"}],"standard_charges":[{"gross_charge":242.97,"discounted_cash":60.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipilimumab 50 mg/10 mL solution 10 mL Vial","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"3232711","type":"NDC"}],"standard_charges":[{"gross_charge":67829.38,"discounted_cash":16957.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topotecan per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"703471471","type":"NDC"}],"standard_charges":[{"gross_charge":798.26,"discounted_cash":199.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topotecan per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"703471401","type":"NDC"}],"standard_charges":[{"gross_charge":798.26,"discounted_cash":199.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"topotecan per 0.1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"409030201","type":"NDC"}],"standard_charges":[{"gross_charge":517.05,"discounted_cash":129.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"pamidronate per 30 mg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"59923060110","type":"NDC"}],"standard_charges":[{"gross_charge":126.54,"discounted_cash":31.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"9008202","type":"NDC"}],"standard_charges":[{"gross_charge":483.84,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"irinotecan per 20 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"55150035401","type":"NDC"}],"standard_charges":[{"gross_charge":766.04,"discounted_cash":191.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ipilimumab per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"3232822","type":"NDC"}],"standard_charges":[{"gross_charge":271316.89,"discounted_cash":67829.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789022010","type":"NDC"}],"standard_charges":[{"gross_charge":164.69,"discounted_cash":41.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"sodium chloride 0.9% with KCl 40 mEq/L 40 mEq/L parenteral solution 1,000 mL Bag","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"97710523905","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":25.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, hydroxocobalamin, 10 mcg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"11704037001","type":"NDC"}],"standard_charges":[{"gross_charge":6333.13,"discounted_cash":1583.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"71288011754","type":"NDC"}],"standard_charges":[{"gross_charge":340.87,"discounted_cash":85.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"25021023952","type":"NDC"}],"standard_charges":[{"gross_charge":171.24,"discounted_cash":42.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"67457061810","type":"NDC"}],"standard_charges":[{"gross_charge":693.82,"discounted_cash":173.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"409018201","type":"NDC"}],"standard_charges":[{"gross_charge":217.57,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"71288011728","type":"NDC"}],"standard_charges":[{"gross_charge":168.62,"discounted_cash":42.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"72485022210","type":"NDC"}],"standard_charges":[{"gross_charge":49.96,"discounted_cash":12.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"25021023926","type":"NDC"}],"standard_charges":[{"gross_charge":124.7,"discounted_cash":31.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457061730","type":"NDC"}],"standard_charges":[{"gross_charge":115.84,"discounted_cash":28.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"45963062458","type":"NDC"}],"standard_charges":[{"gross_charge":105.56,"discounted_cash":26.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"409018101","type":"NDC"}],"standard_charges":[{"gross_charge":117.25,"discounted_cash":29.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"71288011706","type":"NDC"}],"standard_charges":[{"gross_charge":53.47,"discounted_cash":13.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"72485022102","type":"NDC"}],"standard_charges":[{"gross_charge":14.26,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"60505611306","type":"NDC"}],"standard_charges":[{"gross_charge":36.54,"discounted_cash":9.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457061610","type":"NDC"}],"standard_charges":[{"gross_charge":41.58,"discounted_cash":10.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"409018301","type":"NDC"}],"standard_charges":[{"gross_charge":35.38,"discounted_cash":8.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 600 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323035120","type":"NDC"}],"standard_charges":[{"gross_charge":540.03,"discounted_cash":135.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine liposome 1.3 % (13.3 mg/mL) suspension 10 mL Vial","drug_information":{"unit":0.79699,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65250013310","type":"NDC"}],"standard_charges":[{"gross_charge":1399.38,"discounted_cash":349.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"rifAMPin 600 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68059701","type":"NDC"}],"standard_charges":[{"gross_charge":647.27,"discounted_cash":161.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 mcg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323064994","type":"NDC"}],"standard_charges":[{"gross_charge":599.32,"discounted_cash":149.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598063652","type":"NDC"}],"standard_charges":[{"gross_charge":46.73,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598063610","type":"NDC"}],"standard_charges":[{"gross_charge":46.73,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150024747","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457026500","type":"NDC"}],"standard_charges":[{"gross_charge":85.03,"discounted_cash":21.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789011008","type":"NDC"}],"standard_charges":[{"gross_charge":107.24,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"70860060241","type":"NDC"}],"standard_charges":[{"gross_charge":61.28,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"70860060282","type":"NDC"}],"standard_charges":[{"gross_charge":61.28,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598063552","type":"NDC"}],"standard_charges":[{"gross_charge":39.83,"discounted_cash":9.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150024647","type":"NDC"}],"standard_charges":[{"gross_charge":52.85,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levETIRAcetam in NaCl (iso-os) per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457025500","type":"NDC"}],"standard_charges":[{"gross_charge":68.17,"discounted_cash":17.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 mcg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70710183301","type":"NDC"}],"standard_charges":[{"gross_charge":356.88,"discounted_cash":89.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 mcg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021046810","type":"NDC"}],"standard_charges":[{"gross_charge":412.87,"discounted_cash":103.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 mcg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70860045110","type":"NDC"}],"standard_charges":[{"gross_charge":406.59,"discounted_cash":101.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 mcg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"66794064902","type":"NDC"}],"standard_charges":[{"gross_charge":1098.52,"discounted_cash":274.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 mcg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42023020101","type":"NDC"}],"standard_charges":[{"gross_charge":485.8,"discounted_cash":121.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"levothyroxine 100 mcg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323064907","type":"NDC"}],"standard_charges":[{"gross_charge":872.63,"discounted_cash":218.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPivacaine liposome 1.3 % (13.3 mg/mL) suspension 20 mL Vial","drug_information":{"unit":0.3985,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"65250026620","type":"NDC"}],"standard_charges":[{"gross_charge":961.53,"discounted_cash":240.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026930","type":"NDC"}],"standard_charges":[{"gross_charge":36.77,"discounted_cash":9.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"83634060351","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026978","type":"NDC"}],"standard_charges":[{"gross_charge":79.66,"discounted_cash":19.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026977","type":"NDC"}],"standard_charges":[{"gross_charge":39.83,"discounted_cash":9.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026970","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"25021060851","type":"NDC"}],"standard_charges":[{"gross_charge":101.88,"discounted_cash":25.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"25021060850","type":"NDC"}],"standard_charges":[{"gross_charge":50.94,"discounted_cash":12.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026969","type":"NDC"}],"standard_charges":[{"gross_charge":79.66,"discounted_cash":19.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026959","type":"NDC"}],"standard_charges":[{"gross_charge":39.83,"discounted_cash":9.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026994","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"gross_charge":72.77,"discounted_cash":18.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026950","type":"NDC"}],"standard_charges":[{"gross_charge":36.77,"discounted_cash":9.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid-mannitol-water per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"409422901","type":"NDC"}],"standard_charges":[{"gross_charge":138.65,"discounted_cash":34.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid-mannitol-water per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021082666","type":"NDC"}],"standard_charges":[{"gross_charge":425.9,"discounted_cash":106.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"zoledronic acid-mannitol-water per 1 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021082682","type":"NDC"}],"standard_charges":[{"gross_charge":322.49,"discounted_cash":80.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Injection, hydroxocobalamin, 10 mcg","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50633031011","type":"NDC"}],"standard_charges":[{"gross_charge":7235.71,"discounted_cash":1808.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"591213680","type":"NDC"}],"standard_charges":[{"gross_charge":44.12,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"591213695","type":"NDC"}],"standard_charges":[{"gross_charge":44.12,"discounted_cash":11.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"409469953","type":"NDC"}],"standard_charges":[{"gross_charge":32.56,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"409469954","type":"NDC"}],"standard_charges":[{"gross_charge":65.11,"discounted_cash":16.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"83634060343","type":"NDC"}],"standard_charges":[{"gross_charge":68.94,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026922","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034544","type":"NDC"}],"standard_charges":[{"gross_charge":19.3,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034531","type":"NDC"}],"standard_charges":[{"gross_charge":15.63,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"69024810","type":"NDC"}],"standard_charges":[{"gross_charge":75.83,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"69024801","type":"NDC"}],"standard_charges":[{"gross_charge":75.83,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"69023420","type":"NDC"}],"standard_charges":[{"gross_charge":37.92,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"brentuximab vedotin 50 mg recon soln 1 each Vial","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9042","type":"HCPCS"},{"code":"51144005001","type":"NDC"}],"standard_charges":[{"gross_charge":96776.21,"discounted_cash":24194.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"69023401","type":"NDC"}],"standard_charges":[{"gross_charge":37.92,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"641619401","type":"NDC"}],"standard_charges":[{"gross_charge":75.07,"discounted_cash":18.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598026558","type":"NDC"}],"standard_charges":[{"gross_charge":12.41,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598054952","type":"NDC"}],"standard_charges":[{"gross_charge":58.22,"discounted_cash":14.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598054910","type":"NDC"}],"standard_charges":[{"gross_charge":58.22,"discounted_cash":14.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598054850","type":"NDC"}],"standard_charges":[{"gross_charge":31.02,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598054821","type":"NDC"}],"standard_charges":[{"gross_charge":31.02,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598026520","type":"NDC"}],"standard_charges":[{"gross_charge":13.63,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"propofol per 10 mg","drug_information":{"unit":1.0,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"641619410","type":"NDC"}],"standard_charges":[{"gross_charge":75.07,"discounted_cash":18.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"gadobenate dimeglumine per 1 mL","drug_information":{"unit":0.66667,"type":"ML"},"code_information":[{"code":"636","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"270516414","type":"NDC"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":8.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HC ROOM AND CARE","code_information":[{"code":"12100000","type":"CDM"},{"code":"0121","type":"RC"}],"standard_charges":[{"gross_charge":10815.0,"discounted_cash":2703.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE LEVEL 2","code_information":[{"code":"12100001","type":"CDM"},{"code":"0121","type":"RC"}],"standard_charges":[{"gross_charge":10815.0,"discounted_cash":2703.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-MATERNITY LEVEL 1","code_information":[{"code":"12200001","type":"CDM"},{"code":"0122","type":"RC"}],"standard_charges":[{"gross_charge":7180.0,"discounted_cash":1795.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-MATERNITY LEVEL 2","code_information":[{"code":"12200002","type":"CDM"},{"code":"0122","type":"RC"}],"standard_charges":[{"gross_charge":10815.0,"discounted_cash":2703.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-LABOR ROOM","code_information":[{"code":"12200003","type":"CDM"},{"code":"0122","type":"RC"}],"standard_charges":[{"gross_charge":10815.0,"discounted_cash":2703.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-PEDIATRIC","code_information":[{"code":"12300000","type":"CDM"},{"code":"0123","type":"RC"}],"standard_charges":[{"gross_charge":10815.0,"discounted_cash":2703.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE -PEDIATRIC LEVEL 2","code_information":[{"code":"12300001","type":"CDM"},{"code":"0123","type":"RC"}],"standard_charges":[{"gross_charge":10815.0,"discounted_cash":2703.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-PSYCHIATRIC","code_information":[{"code":"12400000","type":"CDM"},{"code":"0124","type":"RC"}],"standard_charges":[{"gross_charge":8025.0,"discounted_cash":2006.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE PSYCHIATRIC LEVEL 2","code_information":[{"code":"12400001","type":"CDM"},{"code":"0124","type":"RC"}],"standard_charges":[{"gross_charge":8025.0,"discounted_cash":2006.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC HOSPICE SEMI-PRIVATE","code_information":[{"code":"12500000","type":"CDM"},{"code":"0125","type":"RC"}],"standard_charges":[{"gross_charge":8180.0,"discounted_cash":2045.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-INPATIENT REHAB","code_information":[{"code":"12800000","type":"CDM"},{"code":"0128","type":"RC"}],"standard_charges":[{"gross_charge":5445.0,"discounted_cash":1361.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-3-4 BED","code_information":[{"code":"13100000","type":"CDM"},{"code":"0131","type":"RC"}],"standard_charges":[{"gross_charge":10815.0,"discounted_cash":2703.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-PSYCHIATRIC 3-4 BED","code_information":[{"code":"13400000","type":"CDM"},{"code":"0134","type":"RC"}],"standard_charges":[{"gross_charge":8025.0,"discounted_cash":2006.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-INPATIENT REHAB 3-4 BED","code_information":[{"code":"13800000","type":"CDM"},{"code":"0138","type":"RC"}],"standard_charges":[{"gross_charge":5445.0,"discounted_cash":1361.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-NURSERY","code_information":[{"code":"17100000","type":"CDM"},{"code":"0171","type":"RC"}],"standard_charges":[{"gross_charge":6210.0,"discounted_cash":1552.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-NICU 172","code_information":[{"code":"17200000","type":"CDM"},{"code":"0172","type":"RC"}],"standard_charges":[{"gross_charge":17125.0,"discounted_cash":4281.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-NICU 173","code_information":[{"code":"17300000","type":"CDM"},{"code":"0173","type":"RC"}],"standard_charges":[{"gross_charge":27050.0,"discounted_cash":6762.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-NICU 174","code_information":[{"code":"17400000","type":"CDM"},{"code":"0174","type":"RC"}],"standard_charges":[{"gross_charge":33210.0,"discounted_cash":8302.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-CRITICAL CARE LEVEL 1","code_information":[{"code":"20000001","type":"CDM"},{"code":"0200","type":"RC"}],"standard_charges":[{"gross_charge":27150.0,"discounted_cash":6787.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-CRITICAL CARE LEVEL 2","code_information":[{"code":"20000002","type":"CDM"},{"code":"0200","type":"RC"}],"standard_charges":[{"gross_charge":35710.0,"discounted_cash":8927.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-PROGRESSIVE CARE","code_information":[{"code":"20600000","type":"CDM"},{"code":"0206","type":"RC"}],"standard_charges":[{"gross_charge":21856.0,"discounted_cash":5464.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-PROGRESSIVE CARE LEVEL 2","code_information":[{"code":"20600001","type":"CDM"},{"code":"0206","type":"RC"}],"standard_charges":[{"gross_charge":21856.0,"discounted_cash":5464.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-TELEMETRY","code_information":[{"code":"21900000","type":"CDM"},{"code":"0219","type":"RC"}],"standard_charges":[{"gross_charge":13725.0,"discounted_cash":3431.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC ROOM AND CARE-TELEMETRY LEVEL 2","code_information":[{"code":"21900001","type":"CDM"},{"code":"0219","type":"RC"}],"standard_charges":[{"gross_charge":13725.0,"discounted_cash":3431.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC NITRIC OXIDE, PER 1 HOUR","code_information":[{"code":"25000001","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"gross_charge":662.92,"discounted_cash":165.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DECLOT THROMBOLYTC OF VAD OR CATH","code_information":[{"code":"26036593","type":"CDM"},{"code":"0260","type":"RC"}],"standard_charges":[{"gross_charge":1504.0,"discounted_cash":376.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC REFIL/MAINT IMPLANTABLE SPINAL OR BRAIN DRUG DELIVERY PUMP OR RESERVOIR","code_information":[{"code":"26095990","type":"CDM"},{"code":"0260","type":"RC"},{"code":"95990","type":"HCPCS"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":253.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION,HYDRATION,INIT,31-60 MIN","code_information":[{"code":"26096360","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1827.0,"discounted_cash":456.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION,HYDRATION,EA ADD HR","code_information":[{"code":"26096361","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.0,"discounted_cash":286.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION,INITIAL,UP TO 1 HR","code_information":[{"code":"26096365","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1904.0,"discounted_cash":476.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION,EA ADD HR","code_information":[{"code":"26096366","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":176.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION,EA ADD SEQ,UP TO 1 HR","code_information":[{"code":"26096367","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":1004.0,"discounted_cash":251.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION, CONCURRENT","code_information":[{"code":"26096368","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":169.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION IV PUSH, SINGLE/INITIAL","code_information":[{"code":"26096374","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION IV PUSH,EA SEQ-NEW MED","code_information":[{"code":"26096375","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.0,"discounted_cash":240.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION IV PUSH,EA SEQ-SAME MED","code_information":[{"code":"26096376","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.0,"discounted_cash":240.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC IRRIGATION VENOUS ACCESS DEVICE","code_information":[{"code":"26096523","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":88.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC DECLOT THROMBOLYTC OF VAD OR CATH (36593)","code_information":[{"code":"26936593","type":"CDM"},{"code":"0260","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.0,"discounted_cash":376.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION,HYDRATION,INIT,31-60 MIN OBED","code_information":[{"code":"26996360","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1827.0,"discounted_cash":456.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION,HYDRATION,EA ADD HR OBED","code_information":[{"code":"26996361","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.0,"discounted_cash":286.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION,INITIAL,UP TO 1 HR OBED","code_information":[{"code":"26996365","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1904.0,"discounted_cash":476.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INFUSION,EA ADD HR OBED","code_information":[{"code":"26996366","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":176.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION IV PUSH, SINGLE/INITIAL OBED","code_information":[{"code":"26996374","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":1299.0,"discounted_cash":324.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION IV PUSH,EA SEQ-NEW MED OBED","code_information":[{"code":"26996375","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.0,"discounted_cash":240.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HC INJECTION IV PUSH,EA SEQ-SAME MED OBED","code_information":[{"code":"26996376","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.0,"discounted_cash":240.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER ABDOMINAL 3 PANEL 45-62IN M/L","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":45.32,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":48.41,"discounted_cash":12.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER BREAST XXLARGE 45-50IN","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HALTER TRACTION DISCARD COTTON FOAM UNIVERSAL HEAD ADJUSTABLE CHIN PAD 6104-00","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":35.23,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER BREAST XLG 40-45\" XL/L-BBIND COMFY","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER BREAST LG 36-40 L/L- BBIND COMFY","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT PATIENT POSITIONER SCHLEIN 5345","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":328.06,"discounted_cash":82.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MARKERS FIDUCIAL MM3002","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":31.62,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":31.62,"discounted_cash":7.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER BREAST MEDIUM 34-36IN","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER ABDOMINAL 4 PANEL 45-62IN UNIV 79-89091","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":54.08,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HOLDER DALE FOLEY CATHETER 316","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":36.05,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POST PAD CHICK TABLEPERINEAL BRACE 10374","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":74.68,"discounted_cash":18.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PAD DEFIB ADULT HEART SYNC 6600099H","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":190.55,"discounted_cash":47.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER ABDOMINAL 4 PANEL 85-100IN 3XL","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":79.83,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER ABDOMINAL 4 PANEL 72-84IN 2XL","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":77.97,"discounted_cash":19.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER ABDOMINAL 4 PANEL 6-74IN XLG","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":74.26,"discounted_cash":18.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER ABDOMINAL 4 PANEL 30-45IN S/M","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":66.23,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER ABDOMINAL 3 PANEL 62-74IN XL","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":67.67,"discounted_cash":16.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AIRWAY NASAL 30FR ROBERTAZZI PVC","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":18.23,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CERVICAL TRACTION HEADHALTER","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":29.46,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PAD THERAPEUTIC ARCTICGEL MEDIUM KIT","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AIRWAY NASAL 32FR ROBERTAZZI","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":18.23,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EASY CAP FOR CO2 DETECTOR ON ER INTUBATION MODULE","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":79.93,"discounted_cash":19.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADAPTER VALVED T 22MM CF2060","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":13.49,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AIRWAY ORAL BERMAN 100MM SZ 5 RED","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AIRWAY ORAL BERMAN 90MM SZ 4 YELLOW #121904","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER ABDOMINAL 3 PANEL 30-45IN S/M","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":44.29,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AEROCHAMBER PLUS W/MOUTHPIECE 79850 FLOW-VU AVHC","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":82.81,"discounted_cash":20.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AEROCHAMBER PLUS W/MOUTHPIECE 79810 FLOW-VU  AVHC","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":82.81,"discounted_cash":20.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONVERTER ARTHROSCOPY SPECIMEN SUCTION SOCK POUCH","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":12.57,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAST PLASTER SPLINT 4X15 FAST SET 7391","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":71.48,"discounted_cash":17.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POST-OP SHOE WOMEN LG-SIZE 8-10","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":50.06,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"*DO NOT USE*CAST ORTHOGLASS SPLINT 4","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":386.25,"discounted_cash":96.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAST PLASTER SPLINT 5X30 FAST SET #7392","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":2.88,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POST-OP SHOE WOMEN MED-SIZE 6-8","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":50.06,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POST-OP SHOE MEN'S LARGE SIZE 11-13","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":50.06,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE LITHOTRIPTER 8.5FR W/ADAPTOR  TTCL-1 G25472","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STYLET 12FR 4.0MM FLEXI-SLIP","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":17.61,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CARD SMART SINGLE USE VERIQ","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":2461.7,"discounted_cash":615.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH SECURACATH 5FR SUBCUTANEOUS SECUREMENT","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PAD THERAPEUTIC ARCTICGEL LARGE KIT","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POST-OP SHOE MEN'S MEDIUM SIZE 9-11","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":47.69,"discounted_cash":11.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"6- SHOOTER (FOR ALL SCOPES) CONTAINS LATEX","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":2626.5,"discounted_cash":656.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TALCAIR POWDER BLOWER 109001T","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":540.75,"discounted_cash":135.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS RAT-TOOTH ALLIGATOR-JAW NON-STERILE FG-42L-1","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":4078.39,"discounted_cash":1019.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NICOM CHEETAH PRESSURE SENSOR PREATTACH LEADWIRE CMS25","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":1678.9,"discounted_cash":419.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ON-Q PAIN PUMP 100ML P100X2","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":587.1,"discounted_cash":146.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"***DO NOT USE*** BINDER UNIV 4-PANEL 12IN 45-62 79-99441","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":79.62,"discounted_cash":19.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE J-HOOK CT SOLID SHAFT 5MM X 32CM #60-5164-001","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":284.8,"discounted_cash":71.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACK SCROTO ELAST STAY 8/PK(12MM) 1/EA(5MM) #3650","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":684.95,"discounted_cash":171.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER FREEMAN MODEL 974 SMALL","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":1215.4,"discounted_cash":303.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOSTON SCS CHARGING KIT NEUROSTIM SC-6412-3","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":23436.0,"discounted_cash":5859.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAST PLASTER SPLINT 3X15 FAST SET 7390","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BINDER FREEMEN MODEL 974 LARGE","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":1215.4,"discounted_cash":303.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POST-OP SHOE MEN'S SMALL SIZE 7-9","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":47.69,"discounted_cash":11.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COVER ULTRASOUND ENDOCAVITY TRANSDUCER 2 X 14CM 610-898 CIVCO MED","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":504.7,"discounted_cash":126.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AEROCHAMBER PLUS W/LARGE MASK 80810 FLOW-VU AVHC","code_information":[{"code":"27100000","type":"CDM"},{"code":"0271","type":"RC"}],"standard_charges":[{"gross_charge":175.4,"discounted_cash":43.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLING ENVELOPE ARM LARGE #79-84027","code_information":[{"code":"27104565","type":"CDM"},{"code":"0271","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.57,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ECONOMY SLING ENVELOPE ARM SMALL 79-84003","code_information":[{"code":"27104565","type":"CDM"},{"code":"0271","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.29,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLING ARM ULTRASLING III BLACK MEDIUM 11-0449-3","code_information":[{"code":"27104565","type":"CDM"},{"code":"0271","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.71,"discounted_cash":105.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLING ARM PROCARE DELUXE XL #79-84008","code_information":[{"code":"27104565","type":"CDM"},{"code":"0271","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.32,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLING ARM PROCARE DELUXE SM 79-84003","code_information":[{"code":"27104565","type":"CDM"},{"code":"0271","type":"RC"},{"code":"A4565","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.32,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL FIBERTAKS 2.8MM AR-3712-28","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT LAPAROSCOPIC HIPEC IPH-4540","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE PACING MYO ULTRA THIN TEMPORARY DISPOSABLE 60CM SF6010AW","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":223.00,"discounted_cash":55.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM STEM EXTRACTION HIP S7HIP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25110.0,"discounted_cash":6277.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RAIL EXTERNAL FIXATION 9X100 MM M710","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8325.24,"discounted_cash":2081.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADAPTER CARDIOPLEGIA DLP Y LUER COLOR CODED CLAMP 10005","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":86.45,"discounted_cash":21.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT THERMOCHEM HYPOTHERMIA DISPOSABLE IPH-2000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":32224.5,"discounted_cash":8056.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CANNULA FEMORAL ATERIAL-INTERNAL JUGULAR VENOUS 17FR 31.8x18.CM96530-117","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3769.8,"discounted_cash":942.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WAND WEREWOLF FASTSEAL HEMOSTASIS SZ 6 72290042","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CANNULA FEMORAL ATERIAL-INTERNAL JUGULAR VENOUS 19FR 31.8x18.CM96530-119","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3769.8,"discounted_cash":942.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL STEEL ACORN M1 9MM 5220-030-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":870.66,"discounted_cash":217.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR  ELITE DIAMOND NEURO 3MM 5820-107-230","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1171.21,"discounted_cash":292.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL ACFS 4X14MM CZ0940014","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER ENDO GIA EXTRA THICK BLACK 60MM SIGTRSB60AXT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER TRI-STAPLE MEDIUM THICK PURPLE 60MM SIGTRSB60AMT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE ASPIRATION VIZISHOT 2 21G NA-U401SX-4021-A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1899.32,"discounted_cash":474.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON MULTIPASS BLACK 3-0 PS-1 18IN 1663H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.41,"discounted_cash":7.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLAMP EXTERNAL FIXATION TRAVEL UNIVERSAL MINIRAIL M702","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13533.02,"discounted_cash":3383.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIXATION KIRSCHNER THREAD 1.6MM 8290-16-006","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":236.39,"discounted_cash":59.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT EXTERNAL FIXATION MINIRAIL ADJUSTMENT REMOVAL M901","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5748.38,"discounted_cash":1437.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER SUREFORM 30 GRAY 2.0 4ROW 8MM 48230M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 BV-1 4 STRAND BLUE M8805","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":402.32,"discounted_cash":100.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL ROUTER CUTTING TPX 1.5X8MM 6515-008-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":820.91,"discounted_cash":205.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE TRACHEOSTOMY SHILEY CUFFED ADULT 6.5X62MM 4CN65H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":375.02,"discounted_cash":93.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INSTRUMENT FIBULOCK STERILE DISPOSABLE AR-8973RK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13515.0,"discounted_cash":3378.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SCREWDRIVER APTUS CANNULATED SELF HOLDING 0.8X75MM A-2716","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5415.01,"discounted_cash":1353.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR PROSTEP CARTILAGE MIS ARTHRODESIS 4X16MM 58CC4016","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4820.4,"discounted_cash":1205.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER IMPLANT MODERATE PLUS PROJECTION ROUND 485CC SZ10621-485MP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING BIOPATCH 1 x 7mm ANTIMICROBIAL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":57.99,"discounted_cash":14.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TEGADERM 6-3/4 X 6-3/8 HYDROCOLLOID #M90007 DRESSING","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":62.11,"discounted_cash":15.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN JACKSON/PRATT RESERVOIR 100CC SU130-1305","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.51,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":41.38,"discounted_cash":10.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":41.45,"discounted_cash":10.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DERMABOND ADHESIVE MINI DHVM12","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":82.4,"discounted_cash":20.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLOSURE SKIN DERMABOND PRINEO 22CM CLR222US","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":709.16,"discounted_cash":177.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX 4-0 MONOCRYL+ KNOTLSS TISSUE SXMP1B119","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":179.17,"discounted_cash":44.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BUTTON GASTROSTOMY MIC-KEY 20FR x 2.5cm ENFIT 8140-20-2.5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":938.95,"discounted_cash":234.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"2-0 20CM STRATAFIX SPIRAL MOMCRYL PLUS SXMP1B409","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":215.58,"discounted_cash":53.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":215.58,"discounted_cash":53.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CVC CATH KIT 3 LUMEN 7FR 16CM CDC-42703-XPN1A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1542.94,"discounted_cash":385.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STANDARD CONNECTING TUBE 14FR 30CM #G14119","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":215.06,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":215.06,"discounted_cash":53.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY THORACENTESIS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":576.39,"discounted_cash":144.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR 11F X 20CM .038-COOK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT DRAINAGE PLEURX 1000ML VACUUM BOTTLE 50-7510","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":509.54,"discounted_cash":127.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL AO STRUXXURE REUSABLE 14MM 31-06-14","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOOP VESSEL YELLOW ELLIPSE .03X30IN 011303PBX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":327.95,"discounted_cash":81.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS CODMAN VERSATRU STANDARD BIPOLAR NONSTICK DISPOSABLE 0.5MM 8IN 9008050ST","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3025.32,"discounted_cash":756.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS CODMAN VERSATRU STANDARD BIPOLAR NONSTICK DISPOSABLE 1MM 8IN 9008100ST","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3025.32,"discounted_cash":756.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT EXTERNAL FIXATION FEMORAL NECK SYSTEM 90MM 04.168.290S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4758.6,"discounted_cash":1189.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT EXTRACTOR SCREW 2.7/2.8 MM 309.290","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":937.3,"discounted_cash":234.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE REAMER HOLLOW SPARE SCREW REMOVAL 309.038","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2429.77,"discounted_cash":607.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE V-LOC 90 SURGALLOY 3-0 V-20 VLOCM0644","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":283.97,"discounted_cash":70.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER SUREFOAM 30 WHITE 2.5 4ROW 8MM 48230W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER SUREFORM 30 CURVED TIP 8MM 488530","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER SUREFOAM 30 BLUE 3.5 4ROW 48230B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL HOFFMANN SS DISPOSABLE GRAY PIN 5MM 4X200MM 5085-2-040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1256.6,"discounted_cash":314.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT SHEATH AXONICS DILATOR 9011","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1541.6,"discounted_cash":385.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAP EXTERNAL FIXATION PROTECTIVE THREAD PIN 1.6/2MM M905","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":669.5,"discounted_cash":167.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HOOK ARTHROSCOPIC SHARP AR-8943-21","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":180.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 3-0 BRAID 8 STRAND COATED UNDYED 18IN J864D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":90.9,"discounted_cash":22.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":90.90,"discounted_cash":22.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD ETHICON 3D BLUE ER60B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1655.72,"discounted_cash":413.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUN STANDARD 4000 ETHICON EC3D60S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4275.74,"discounted_cash":1068.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD ETHICON 3D WHITE ER60W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1573.43,"discounted_cash":393.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TIP BAER TYMPANOMETER FOAM PEDIATRIC EAR CONNECTOR 4MM T001 202692-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":276.76,"discounted_cash":69.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TIP BAER TYMPANOMETER FOAM NEONATE EAR CONNECTOR 4MM T002 202691-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":165.52,"discounted_cash":41.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT AUDIOMETER ER-3C 10ohms 198235-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE BLADE ABC PUSH BUTTON HANDCONTROL DISPOSABLE 10FT 130344","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":620.28,"discounted_cash":155.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS CODMAN VERSATRU STANDARD BIPOLAR NONSTICK DISPOSABLE 0.5MM 9IN 9009050ST","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3025.32,"discounted_cash":756.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLAMP  DETACH AORTIC DETACHABLE CROSS HEAD MEDIUM 65MM MI-XCHM-651","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRY PLUS 4-0 27IN PS-3 MCP426H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":43.98,"discounted_cash":11.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":43.21,"discounted_cash":10.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTION IMPLANT KNEE UNIVERSAL S7KNEE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":27621.0,"discounted_cash":6905.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSTEOTOME Z ROUND TIP 2CM X 16MM SBLDZ-2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4017.0,"discounted_cash":1004.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE PTEYE-1 FIBER OPTIC DISP PTEYE-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW BR2000 SAGITTAL LARGE BONE 19X100MM BR1-19100-50","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":259.56,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR DIALYSIS TI 2 PART FLEX-NECK CC-2300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SLEEVE PROTECTION 8-11MM RIGID LONG 03.043.035S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIX KIRSCHNER 1 END TROCAR POINT SMOOTH PLAIN .062X9IN KM172-19-62","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":24.41,"discounted_cash":6.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIXATION KIRSCHNER RADIUS DISTAL TROCAR POINT 1.8X150MM 02.110.300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":106.81,"discounted_cash":26.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR PERFUSION INTERSEPT Y 1/4IN 6030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":32.9,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 0 8-18IN CT-2 #VCP727D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":97.43,"discounted_cash":24.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":96.46,"discounted_cash":24.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":97.54,"discounted_cash":24.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 2-0 8-18IN CT-2 #VCP726D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":94.71,"discounted_cash":23.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":94.86,"discounted_cash":23.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":94.63,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOOP VESSEL SURG-I SILICONE MINI YELLOW 16.5IN 3/32IN 1001-79","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":30.10,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW DUAL CUT SAGITTAL 2108-107-004S1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":194.16,"discounted_cash":48.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DISSECTOR LAPAROSCOPIC SONICISION 7 CURVED JAW CORDLESS ULTRASONIC 5MM 39CM SCD7A39","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5770.36,"discounted_cash":1442.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NASAL SPLINT AIRWAY BREEZE SILICONE DISPOSABLE SP-79300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":358.65,"discounted_cash":89.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ENDOSCOPIC CLEAR PETRA URETERAL ACCESS 11FR 36CM 90111136","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2852.72,"discounted_cash":713.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FOAM BORDER HEEL 9INx9IN #MSC1200B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":24.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":97.74,"discounted_cash":24.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MARKER SURGICAL ENVISIO NAVIGATOR CALIBRATE DISK SCREENLESS (NAV-SLIM) SMARTSENSOR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER SURGICAL INBONE 16 END CUT 22001600","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10019.12,"discounted_cash":2504.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLAMP ELECTROSURGICAL ISOLATOR SYNERGY LONG A001143SB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE EKG NEUROLINE CORKSCREW 120CM 74715-60/24","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE ETHILON BLACK 3-0 FS-1 18IN 663G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.77,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 3-0 SH 27IN VCP416H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.49,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 4-0 FS-2 27IN VCP422H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18.95,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS MULTIPASS 4-0 PS-2 27IN VCP426H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":34.09,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 4-0 FS-1 27IN VCP441H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 0 CT-2 27IN VCP334H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13.7,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY CATH 16FR FOLEY LATEX FREE SURESTEP A942216","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":138.54,"discounted_cash":34.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":138.54,"discounted_cash":34.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 2-0 MO-4 18IN VCP700D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":125.35,"discounted_cash":31.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 1 CTX 18IN VCP765D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":95.07,"discounted_cash":23.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 0 54IN VCP616H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS SUTUPAK 2-0 18IN VCP111G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":73.44,"discounted_cash":18.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS SUTUPAK 3-0 18IN VCP104G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":71.28,"discounted_cash":17.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 0 UR-5 27IN VCP376H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.89,"discounted_cash":4.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 0 CT-1 27IN VCPP31D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":94.35,"discounted_cash":23.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":94.25,"discounted_cash":23.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 0 CT-1 18IN VCP840D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":95.79,"discounted_cash":23.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 0 MO-4 18IN #VCP701D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":128.24,"discounted_cash":32.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE PDS II MONOFILAMENT VIOLET 2-0 CT-2 27IN Z333H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.19,"discounted_cash":5.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEPITEL ANTIMICROBIAL WOUND CONTACT LAYER 2X3 289100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":31.83,"discounted_cash":7.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM VISION TESTING SMARTGUARD DISPOSABLE SG-200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":334.75,"discounted_cash":83.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MARKER MARGIN 6 COLOR MMS6","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1658.4,"discounted_cash":414.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER IAB ARROW FIBEROPTIX 8FR 40CC IAB-05840-LWS-SC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8604.55,"discounted_cash":2151.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS SMOOTH JAW OCCLUDE TUBE 2X6IN 66225","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":108.97,"discounted_cash":27.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR LAPAROSCOPIC VERSAONE STANDARD FIXATION 5X100MM ONB5STF","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":432.39,"discounted_cash":108.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BAG TISSUE RETRIEVAL LARGE EMP200 EMP200ECO-US-5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BAG TISSUE RETRIEVAL EXTRA LARGE EMP600 EMP600ECO-5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRIVER FIBULOCK HEXALOBE T10 AR-8973-11","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE CHROMIC 3-0 CP-2 27IN 886H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.69,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROUTER SURGICAL STRYKER TPX L20 MM OD1.5 MM DISP 6515-020-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":713.79,"discounted_cash":178.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROUTER SURGICAL STRYKER TPX L30 MM OD1.5 MM DISP 6515-030-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":713.79,"discounted_cash":178.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSTEOTOME FLAT 1.2X5CM SBLDFLAT-6","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4017.0,"discounted_cash":1004.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET EXTENSION  MIC-KEY 18FR X 3.0CM ENFIT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":938.95,"discounted_cash":234.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSTEOTOME FLAT 8MMX5CM SBLDFLAT-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4017.0,"discounted_cash":1004.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSTEOTOME FLAT 1X5CM SBLDFLAT-3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4017.0,"discounted_cash":1004.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSTEOTOME FLAT 1X11CM SBLDFLAT-4","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4017.0,"discounted_cash":1004.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYMPHION FLUID MANAGEMENT FG-0204","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4109.7,"discounted_cash":1027.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GASTRIC LAVAGE VISIGI 3D SYSTEM W/ BULB 32FR 5232B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2461.7,"discounted_cash":615.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GASTRIC LAVAGE VISIGI 3D SYSTEM W/ BULB 36FR 5236B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2461.7,"discounted_cash":615.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADHESIVE SKIN CLOSURE SYLKE PURIFIED SILK FIBROIN MESH 2.5X32CM SYL-WC-32-010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":180.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PAD GEL IODOFLEX CADEZOMER IODINE 10GM 6602134010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":51.09,"discounted_cash":12.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM EXTERNAL DRAINAGE DUET WITH SMARTSITE 46914","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2010.76,"discounted_cash":502.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2010.77,"discounted_cash":502.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ENDOSCOPIC CLEAR PETRA URETERAL ACCESS 11FR 46CM XUSM0046","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7946.82,"discounted_cash":1986.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":4221.76,"discounted_cash":1055.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC CONTAINER SPECIMEN SHEATH STONE COLLECTION 10-22FR 140ML 79880140","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GASTRIC LAVAGE VISIGI SYSTEM W/BULB 3D 40FR 5240B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2461.7,"discounted_cash":615.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM MEPILEX SILVER 4 X 4IN 395390","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":95.17,"discounted_cash":23.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL ACORN MEDIUM 9MM 5120-030-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":835.74,"discounted_cash":208.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE ATRICLIP FLEXV 1 HAND SMALL 50MM ACHV50","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16668.5,"discounted_cash":4167.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING NASAL RAPID RHINO STAMMBERGER SINU-FOAM RR650","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":919.79,"discounted_cash":229.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE DRILL FIXATION LOCK VARIABLE ANGLE CORTICAL 3.5MM AR-8943-43","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TIP ASPIRATION TISSUE CLARITY SHEAR TIP CURVED C7417SEA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10785.6,"discounted_cash":2696.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUCTION CUSA CLARITY QUICK CONNECT TUBE SET C7300EA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5143.72,"discounted_cash":1285.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MILL BONE FINE BLADE DISP 5420-FNE-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MILL BONE BIOPSY MEDIUM DISPOSABLE 5420-MED-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE ATRICLIP FLEXV 1 HAND SMALL 35MM ACHV35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET EXTENSION MIC-KEY 18FR X 4.0CM ENFIT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":938.95,"discounted_cash":234.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BIOPSY CORVOCET SYSTEM 18G X 15CM CORCA1815B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR VASCULAR COONS TAPER 16FR 20CM G03947","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL 22GA 6IN 408268","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.27,"discounted_cash":10.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE CHIBA BIOPSY 20GX10CM-COOK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":118.86,"discounted_cash":29.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE CHIBA BIOPSY 22GX20CM-COOK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.8,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRUCLOSE SUCTION DRAINAGE SYSTEM W/PORT #TCS500D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":324.45,"discounted_cash":81.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CO-AXIAL NEEDLE 17G X 6.8CM #MCXS1810BP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.88,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CO-AXIAL NEEDLE 17G X 11.8CM #MCXS1815BP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.88,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CO-AXIAL NEEDLE 17G 16.8CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.88,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL 25GA  X 3 BLUE 405170","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10.82,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KYPHOPLASTY EXPRESS BONE BIOPSY DEVICE SIZE 2-KYPHON F07A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":948.12,"discounted_cash":237.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DERMABOND HIGH VISCOSITY DNX12","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":162.23,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":162.22,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL STERILE 25GAX3.5IN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.83,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":14.47,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL SPROTTE PENCIL 22GA X 4.75IN #03115130C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE OSTEOCOOL DUAL RF 17GA 20MM ABLATION OCP220","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":38156.57,"discounted_cash":9539.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOTTLE DRAINAGE ONE-VAC 1000ML EVAC1000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":92.19,"discounted_cash":23.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN INCISION JACKSON-PRATT HEMADUCT SILICONE ROUND 15FR 30CM JP-HUR880","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.09,"discounted_cash":38.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KYPHON EXPRESS CURETTE T-TIP SZ2 A13A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3783.6,"discounted_cash":945.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WATER STERILE IRR 500ML #2F7113","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.74,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHIBA BIOPSY NEEDLE 21X10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":101.87,"discounted_cash":25.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHIBA BIOPSY NEEDLE 20X15","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.80,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":133.8,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 18IN BLU MONO SA P-3 8695G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.17,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 6-0 18IN 3/8 CIR UNDYED J489","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":34.81,"discounted_cash":8.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 4-0 18IN BLK MONO P-3 699G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT VENTRICULOSTOMY 46156","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2790.37,"discounted_cash":697.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SOLUTION O.9%NACL IRRIGATION 3000cc BAG #2B7127","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":101.04,"discounted_cash":25.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"URINARY CATH KIT 5FR INFANT CLOSED SYSTEM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":268.21,"discounted_cash":67.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MONITOR INTRAABDOMINAL PRESSURE IAP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":854.9,"discounted_cash":213.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"URINE BAG WITH/METER URIMETER #153214","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.7,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL BD QUINCKE LONG REGULAR WALL 20GA 6IN 405211","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.02,"discounted_cash":10.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TAMP SURGICAL EXPRESS II 15/2 KIT KEX152NB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17905.39,"discounted_cash":4476.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR VESSEL STANDARD 10FR 20CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR STANDARD 12FR 20CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR STANDARD 14FR 20CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR STANDARD 16FR 20CM #G01212","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT DRAINAGE PLEURX 500ML  50-7500B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":541.78,"discounted_cash":135.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 4-0 G.I.27IN SH #J415H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.77,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHIBA BIOPSY NEEDLE 22X15","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.80,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":133.8,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE CHIBA BIOPSY W/TRAY 22GA 10CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.8,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOCUBE EMBOLIZATION GELATIN 5.0MMx100MG EC50100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN CHEST SINGLE COLLECTION","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":320.74,"discounted_cash":80.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":319.34,"discounted_cash":79.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 16FR 30CC LATEX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":66.02,"discounted_cash":16.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING XEROFORM GAUZE 5IN X 9IN #84-433605","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING DUODERM 4 X4 THICK.","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":27.81,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING DUODERM 4X4 XTRA THIN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10.40,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":10.4,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETHRAL RED RUBBER 10FR 277710","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":6.70,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETHRAL RED RUBBER ROBINSON 16FR 277716","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":6.70,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 1 30IN BLACK DOUBLE ARMED LR NEEDLE 489T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.79,"discounted_cash":5.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 18FR 5CC LATEX 0165S118 BARD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 2-0 18IN BLK MONO FS 664G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 5-0 18IN BLK MONO PC-1 1855G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.22,"discounted_cash":7.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 6-0 18IN BLK MONO PS-3 1665G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 5-0 18IN BLK MONO PS-2 1666G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.03,"discounted_cash":6.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 4-0 18IN BLK MONO FS-2 1667G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.44,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 3-0 BLK BRD SA CR ETC013D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":59.84,"discounted_cash":14.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 3-0 18IN BLK BRD FS-1 684G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 2-0 18IN BLK BRD FS 685G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORB PERMA-HAND SLK 3-0SH L30IN BRAID BLK K832H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9.27,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 6-0 18IN BLK MONO P-1 697G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":26.06,"discounted_cash":6.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY SILICONE 14FR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.02,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 16FR 5CC LATEX  165S116 BARD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 12FR 5CC LATEX #0165SI12","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET BLOOD/FLUID WARMING STANDARD FLOW RANGER 24250","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":86.83,"discounted_cash":21.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TORPEDO GELATIN FOAM 2.5MMX10MM TOR2510","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH TRAY 16FR FOLEY TEMP SENSING LATX SURESTEP A319416A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":357.20,"discounted_cash":89.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":357.2,"discounted_cash":89.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH TRAY 16FR FOLEY LATEX SURESTEP A800365","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":126.07,"discounted_cash":31.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INFANT KIT 5FR GLOVES IODOPHOR SWABSTICK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.7,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE ENDOTRACHEAL ORAL/NASAL HI-LO CUFFED 9.0MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY KRONOS SINGLE PASS GUIDE NEEDLE 10CM 900001SP-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY KRONOS SINGLE PASS GUIDE NEEDLE 15CM 900001SP-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 14FR 5CC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL 22G X 1-1/2 PLASTIC HUB #405161","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IRRIGATION SET CYSTO/BLADDER SINGLE BOTTLE #2C4040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":46.14,"discounted_cash":11.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":45.68,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":46.11,"discounted_cash":11.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING OIL EMULSION (ADAPTIC) GAUZE 3X8 #6113","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8.03,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING HEMOSTATIC SURGICEL ABSORBABLE 2X3IN 1953S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":577.93,"discounted_cash":144.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLE SKIN REMOVER","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36.05,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER SKIN STERILE DISPOSABLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":97.85,"discounted_cash":24.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":97.83,"discounted_cash":24.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":97.67,"discounted_cash":24.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":97.74,"discounted_cash":24.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 3-0 COATED UND BRD 27IN FS-2 J423H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.82,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 4-0 27IN COATED UND BRD FS-2 J422H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.51,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 10FR 3CC LATEX #0165SI10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL 20G X 3-1/2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.30,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":17.3,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":17.16,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PROLENE 3-0 KS 30IN 8622H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.12,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY BIOPENCE ULTRA W/CO-AXIAL 18G 20CM 360-2080-03","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":545.9,"discounted_cash":136.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE INFLATION ADVANTAGE 26 KIT H74904527052","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":404.69,"discounted_cash":101.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"THORACIC VENT PROCEDURE TRAY","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2348.4,"discounted_cash":587.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR STANDARD 8FR 20CM #G00981","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 3-0 18IN BLU PS-1 8663G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36.26,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 5-0 27IN FS-2 #VCP421H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.78,"discounted_cash":4.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAINAGE LINE SET PLEURX 50-7245","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":57.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":230.00,"discounted_cash":57.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE BREAST BIOPSY ATEC 9 GA 14CM 20MM STANDARD DISP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2468.91,"discounted_cash":617.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KYPHOPAK 10/2 EXPRESS II FIRST FRACTURE KIT KEX102EB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23616.12,"discounted_cash":5904.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BIOPSY CORVOCET SYSTEM 18G X 10CM CORCA1810B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":514.9,"discounted_cash":128.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":514.90,"discounted_cash":128.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE FIDUCIAL TIP ECHO ULTRA 22GA G03793","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PARS SUTURE IMPLANT KIT W/SUTURE TAPE AR-8862DS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13469.95,"discounted_cash":3367.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE SCOUT SINGLE-USE DISP HPSU-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":669.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY BIOPINCE ULTRA 18X15CM NEEDLE 360-1580-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":401.7,"discounted_cash":100.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY BIOPINCE ULTRA 16X10CM NEEDLE 370-1080-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":401.7,"discounted_cash":100.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY BIOPINCE ULTRA 16X15CM NEEDLE 370-1580-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":401.7,"discounted_cash":100.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY BIOPINCE ULTRA 18X10CM NEEDLE 360-1080-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":401.7,"discounted_cash":100.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPINCE BLUNT NEEDLE 17G 6.8CM MCXB1810BP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.88,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ATRIUM PVC THORACIC 24FR  #8124","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":68.08,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACHIEVE COAXIAL BIOPSY SYSTEM 18 GA W INTRODUCER CA1811","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":834.3,"discounted_cash":208.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL 22G X 3-1/2 #2290","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTR PROLENE 4-0 18 P-3 8699G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":37.18,"discounted_cash":9.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPINCE BLUNT NEEDLE 17G 16.8CM MCXB1820BP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.88,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL TWIST APTUS 1.8X87MM A-3736","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3965.5,"discounted_cash":991.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BAG EXTERNAL DRAINAGE DEHP-FREE 46912","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":404.27,"discounted_cash":101.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLEARSITE LASER LEVEL ACCESSORY 46918","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":878.18,"discounted_cash":219.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY HIGH TEMPERATURE FIXED 0.5IN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":77.77,"discounted_cash":19.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER UMBILICAL 5Fx15\" 1-LUMEN NEONATAL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":110.83,"discounted_cash":27.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER UMBILICAL 3.5F x 15\" 1-LUMEN NEONATAL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":110.83,"discounted_cash":27.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPINCE BLUNT NEEDLE 17G 11.8CM MCXB1815BP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.88,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER UMBILICAL 3.5Fx15\" 2-LUMEN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":258.12,"discounted_cash":64.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 4-0 18IN P-3 #VCP494G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36.77,"discounted_cash":9.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":35.43,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INTRAUTERINE BAKRI SILICONE 24FR 54X180CM G24237","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4072.31,"discounted_cash":1018.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOUND VAC SMALL DRESSING WHITE FOAM 10X7.5X1cm M6275033/10.S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":86.11,"discounted_cash":21.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOUND VAC DRESSING GRANUFOAM MEDIUM 18 X 12.5 X 3.3CM M8275052","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":367.20,"discounted_cash":91.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":367.2,"discounted_cash":91.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY CARSON COUDE 18FR 0168SI18","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":119.58,"discounted_cash":29.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY CARSON COUDE 16FR 0168SI16","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":119.58,"discounted_cash":29.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY IRRIGATION 3-WAY 18FR 0119L18","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":103.93,"discounted_cash":25.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 16FR5CC SILASTIC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.02,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING SURGICEL 1/2 X 2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":284.80,"discounted_cash":71.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADHESIVE GEL HEMOSTATIC D-STAT FLOWABLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1178.32,"discounted_cash":294.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE MARROW ASPIRATE CONCENTRATE PROC PK 11G BMAC230-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BIOPSY CHIBA 22GA 10CM G03978","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":141.83,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BONE MARROW BIOPSY 11GA 4IN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":262.65,"discounted_cash":65.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VERTEBROPLASTY SIZE2 XPRES OSTEO INTRODUCER DEVICE-MEDTRONIC T34A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7229.98,"discounted_cash":1807.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ON-CONTROL BONE LESION BIOPSY TRAY10GA 15CM ACCESS 12GA 19CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3812.34,"discounted_cash":953.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GASTROSTOMY MIC 18FR G-TUBE INTRODUCER KIT 98433","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1924.45,"discounted_cash":481.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT OSTEOCOOL BONE ACCESS ABLATION SYSTEM 10GA OCN002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4544.88,"discounted_cash":1136.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY BIOPINCE ULTRA 18X20CM NEEDLE 360-2080-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":401.7,"discounted_cash":100.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KYPHOPAK 15/2 EXPRESS II FIRST FRACTURE KIT KEX152EB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23616.12,"discounted_cash":5904.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIXATION KIRSCHNER APTUS TROCAR TIP .8X100MM A-5040.00/1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":298.7,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TENSIONER CERCLAGE ARTHREX AR-7820","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ENDO STITCH SOFSILK 2-0 #170002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":442.08,"discounted_cash":110.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE VERSASTEP INSUFFLATION/ACCESS 14GA S100000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":259.15,"discounted_cash":64.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR VERSASTEP REPOSABLE 5MM #VSR100005","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":647.15,"discounted_cash":161.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA VENOUS DLP RT ANGLE SINGLE STAGE 28FR 67528","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":284.48,"discounted_cash":71.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOURNIQUET SET DLP 5 TUBES 79006","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":48.31,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA ARTERIOTOMY DLP 2MM BULB TIP31002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":83.84,"discounted_cash":20.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA ARTERIOTOMY DLP 3MM BULB TIP #31003","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":83.84,"discounted_cash":20.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE RECIPROCATING HEAVY DUTY LONG 0277-096-325","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":257.81,"discounted_cash":64.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE NERVE MONITOR STANDARD PRASS FLUSH-TIP MONOPOLAR STIMULATOR NIM 0.5MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1219.19,"discounted_cash":304.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTR VICRYL 0 42 ENDOKNOT JK10G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":202.5,"discounted_cash":50.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACKING POPE EPISTAX-IS 10CM + STRING","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1950.1,"discounted_cash":487.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRIEVER HEWSON SUTURE 71111579","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1234.35,"discounted_cash":308.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IRRIGATION SET BLADDER TUR Y-TYPE 2C4041","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":87.14,"discounted_cash":21.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MINI CAP EXTENDED LIFE PD TRANSFER SET 5C4482","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":595.03,"discounted_cash":148.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR BLADELESS X-CEL 12MM B12LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.13,"discounted_cash":44.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR STABILITY SLEEVE X-CEL 12MM CB12LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":123.29,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIPS HEM-O-LOK MLX 544240 PURPLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":326.2,"discounted_cash":81.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":325.80,"discounted_cash":81.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER PROXIMATE HEMORRHOID SET PPH03","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":864.75,"discounted_cash":216.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 3-0 8-18IN COATED VIO BRD SH J774D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":93.94,"discounted_cash":23.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":92.54,"discounted_cash":23.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER COUDE 20 FR-5CC 0168L20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":71.89,"discounted_cash":17.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT CANNULATED 2.7 X 160MM 310.67","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE COAGULATING 24FR POINTED YELLOW","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":960.48,"discounted_cash":240.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ENDO STITCH POLYSORB 0 #170052","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":442.08,"discounted_cash":110.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR SURGICAL LONG 8-11MM 03.043.008S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1320.98,"discounted_cash":330.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SURGINEEDLE ENDO 120MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":292.73,"discounted_cash":73.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO CATCH GOLD 10MM #173050G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1400.08,"discounted_cash":350.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDOCATCH 15MM SPECIMEN POUCH","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1989.65,"discounted_cash":497.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ENDOSCOPIC SURGITIE O CHROMIC LOOP #SGL1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":597.92,"discounted_cash":149.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO PADDLE RETRACTOR 12MM #173046","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2947.45,"discounted_cash":736.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADHESIVE SKIN DERMABOND PROPEN TOPICAL #DNX6","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":170.36,"discounted_cash":42.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE 18FR MOSS GASTROSTOMY 5-17719","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER OPEN PREMIUM PLUS CEEA 28MMX4.8MM EEA28","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDOSTITCH 10MM #173016","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2724.45,"discounted_cash":681.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE ABC 5MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1170.29,"discounted_cash":292.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING SECUREMENT TEGADERM CHG FILM 3.5X4.5IN 1657","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":55.93,"discounted_cash":13.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GORE-TEX CV-O 91CM 36IN 0N07A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":348.45,"discounted_cash":87.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IFUSE BEDROCK GRANITE SCREW SET DISP 501117","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1442.0,"discounted_cash":360.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL LOCK 4.2X360MM 2351-4236S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2554.4,"discounted_cash":638.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIXATION KIRSCHNER 3X285MM 2351-3028S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1637.7,"discounted_cash":409.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE FEEDING ENFIT 5FR 36IN 461503E","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":49.34,"discounted_cash":12.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE FEEDING 8FR X 107CM ENFIT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":49.35,"discounted_cash":12.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE SALEM SUMP 18 FR W/GIENTRI PORT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.51,"discounted_cash":18.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLEEVE PROTECTION LONG FLEXIBLE 8-11MM 03.043.033S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE GYRUS ENT SCALPEL #15 7013-5615","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":439.4,"discounted_cash":109.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN TEMP FIXATION APEX TRANSFIX 5/6X40X300MM 5050-4-300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1678.9,"discounted_cash":419.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES K-WIRE TROCAR POINT 2.0 X 150MM 292.20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":82.09,"discounted_cash":20.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GELPORT SYSTEM W/ALEXIS WOUND RETRACTOR C8XX2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6442.15,"discounted_cash":1610.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TAP 3.5MM 311.32","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2592.82,"discounted_cash":648.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 1.8 X 100MM 310.510","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1563.64,"discounted_cash":390.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROTACK 5MM FIXATION INSTRUMENT #PTACK30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2585.71,"discounted_cash":646.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR BLUNT TIP 10MM W/FIXATION BALOON #OMS-T10BT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1458.07,"discounted_cash":364.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 3-0 27IN UND MONO SH #MCP416H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGASURE ATLAS 20CM X10MM OPEN PROCEDURE LS1020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3426.91,"discounted_cash":856.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGASURE ATLAS 37CM LS1037","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3484.39,"discounted_cash":871.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE FIBERWIRE 2 W/TAPERED NEEDLE AR-7200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ABLATION DEVICE ENDOMETRIAL NOVASURE NSV5US-003","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10911.11,"discounted_cash":2727.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 3.2 X 145MM 310.31","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":660.85,"discounted_cash":165.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACC PRIORITY PAK 20-30 KIT INDEFLATOR WITH COPILOT-ABBOTT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":103.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE FIBER WIRE #2-0 W/TAPERED NEEDLE #AR-7220","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2719.2,"discounted_cash":679.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTOR STONE NCIRCLE TIPLESS 12FR 38CM G27234","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1787.57,"discounted_cash":446.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADHESIVE SURGICAL BIO-GLUE 10ML BG3510-5-US","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8444.17,"discounted_cash":2111.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE MINI SHARP ALL-AROUND BEAVER6900","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":69.83,"discounted_cash":17.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"O- ARM MARKER PASSIVE REFLECTIVE (5 PACK) #PM8005","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":102.49,"discounted_cash":25.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN BLAKE 19 FR ROUND HUBLESS W/O TROCAR #JP-2230","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":141.52,"discounted_cash":35.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":139.86,"discounted_cash":34.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING HEMOSTATIC SURGICEL FIBRILLAR ABSORBABLE 2X4 #1962","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1693.42,"discounted_cash":423.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN 24FR ROUND HUBLESS JJ2234","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":911.45,"discounted_cash":227.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT CANNULATED 5.0 X 300MM 310.63","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SURGICEL HEMOSTATIC ABSORBABLE NU-KNIT 3 INCHX4 INCH #1943","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":434.04,"discounted_cash":108.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR DILATOR AND CANNULA VERSASTEP PLUS 12MM VS101012P","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":991.79,"discounted_cash":247.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR DILATOR AND CANNULA VERSASTEP PLUS 5MM VS101005","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":831.52,"discounted_cash":207.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER ENDO GIA UNIVERSAL XL #EGIAUNIV XL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1668.39,"discounted_cash":417.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COVER PIN YELLOW STERILE 0.028-0.062IN PINS 101001PBX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.13,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPONGE SURGIFOAM ABSORB PORCINE GEL 2X6 1972","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":18.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER GIA 80-3.8 #GIA8038S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3928.52,"discounted_cash":982.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PERFORATOR CRANIAL 14MM W/ HUDSON END","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2173.3,"discounted_cash":543.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANISTER INFO V.A.C. WOUND VAC 500ML W/GEL M8275063/5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":305.5,"discounted_cash":76.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VAC GRANUFOAM MEDIUM M8275052/5 DRESSING","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":493.16,"discounted_cash":123.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 2.7 X 100MM 310.26","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":669.4,"discounted_cash":167.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THORACIC RIGHT ANGLE 28FR #8128","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":64.38,"discounted_cash":16.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":63.86,"discounted_cash":15.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 2.5 X 110MM GOLD QUICK COUPLE 310.25","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":681.67,"discounted_cash":170.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":671.35,"discounted_cash":167.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 3.5 X 110MM 310.35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":709.36,"discounted_cash":177.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CASPAR DISTR PIN 14MM FF904SB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":504.78,"discounted_cash":126.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHROWAND 3.6/90DEG WITH CABLE (REPLACES A1336-01)","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4703.29,"discounted_cash":1175.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN SKULL MAYFIELD ADULT STEEL A-1083","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":589.68,"discounted_cash":147.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE YINGLING FLEX-TIP MONOPOLAR STIMULATOR 0.5mm BALL TIP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1434.69,"discounted_cash":358.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE MINI SHORT NARROW 15X7MM 2296-003-103","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.36,"discounted_cash":54.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER BLADE PRECISION THIN 9.0MM .38MM 18.5MM 2296-003-225","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.36,"discounted_cash":54.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN RND SILICN 1/81/8 MED 070310","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":69.73,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND EXCEL 2-0 4 X 75 RB-1 GRN/WHT PXX41","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":194.05,"discounted_cash":48.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR PERFUSION INTERSEPT REDUCER 3/8X1/2IN 6013","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":26.16,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT 3.5MM AR-4160-35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":813.7,"discounted_cash":203.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LORENZ BATTERY STERILE DISPOSABLE 50-1010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":659.2,"discounted_cash":164.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THORACIC STRAIGHT 24FR #8024","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":55.21,"discounted_cash":13.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER IV ANGIOCATH 16GA 3.25 1.7 X 83MM 127ML/MIN 382258","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":124.12,"discounted_cash":31.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX TAPE FIBER SUTURE TAPER 2MM 7IN AR-7237-7","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHROCARE PLASMA WAND EVAC 70 XTRA EICA5872-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3496.64,"discounted_cash":874.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GRASPER 14GA X 15CM #RSG-14F-4","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":159.65,"discounted_cash":39.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 4-0 PS-2 18IN #MCP513G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.33,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":42.34,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHROWAND SUPER TURBOVAC 90 ASC4250-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4703.29,"discounted_cash":1175.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDOPOUCH RETRIEVER 100 ETPOUCH","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":380.07,"discounted_cash":95.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE NEUROVISION MODULE II 8020015","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7883.75,"discounted_cash":1970.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI NEEDLE DRIVER LARGE SUTURECUT 420296","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI S FORCEPS MARYLAND BIPOLAR #420172","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":695.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACKING VAGINAL 1IN X 5YDS 10-015","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":118.97,"discounted_cash":29.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":110.56,"discounted_cash":27.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KYPHON OSTEO INTRODUCER DEVICE ONE-STEP BEVEL T15K","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3206.08,"discounted_cash":801.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX CANNULA TWIST-IN W/NO SQUIRT CAP 7MM ID 7CM AR-6570","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE M5 XLIF DISPOSABLE KIT 2029950","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6532.25,"discounted_cash":1633.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGASURE SEALER/DIVIDER BLUNT TIP 5MM LF1537","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2811.28,"discounted_cash":702.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS II MONO VIOLET 5-0 30IN DA RB-1 Z320H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":48.1,"discounted_cash":12.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE 1.27X90MM 6118-127-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":518.91,"discounted_cash":129.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 0 VIOLET 27IN CT-2 #PDP334H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.63,"discounted_cash":5.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI S SCISSORS MONOPOLAR CURVED #420179","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3296.0,"discounted_cash":824.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE PRECISION THIN 29.5X7MM 2296-003-115","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":95.07,"discounted_cash":23.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI - MEGA NEEDLE DRIVER 420194","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":566.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI INSTRUMENT 8MM TENACULUM FORCEPS 420207","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":566.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 2-0 VIOLET 27 SH #PDP317H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.09,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":20.08,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN INCISION SILICONE ROUND 10FR 20CM JP-2186","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":160.89,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACK LITHOTOMY 53 X 38 #DYNJP9020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":74.26,"discounted_cash":18.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CEMENT MIXING W/FEMORAL BREAKAWAY NOZZLE #606-593-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1179.04,"discounted_cash":294.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE PIN 2.5MM DIA WITHREAD 230MM LENGTH #900.723","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":448.57,"discounted_cash":112.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO BAG 5X8 SPECIMEN RETRIEVAL SYSTEM 25040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":534.47,"discounted_cash":133.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE EL MONO 5-0 PLASTIC 1811 PS-2 #8686G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":35.74,"discounted_cash":8.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER CLIP ENDO MULTIPLE TITANIUM 13 1/3 20 LG #MCL20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":359.45,"discounted_cash":89.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE. ETHIBOND GRN BR 4-0 CARDIO 30 RB-l.RB-l #X551H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":31.42,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":31.42,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE MAYO #5 #1824D-5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.45,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 2-0 VIOLET 27IN CT-1 #PDP339H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.61,"discounted_cash":4.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":19.67,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY TIPEXTENDER E-Z CLEAN  2 1/2 0012M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":34.3,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX NEEDLE MULTIFIRE SCORPION #AR-13995N","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":437.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET DRILL BIT 2.7MM CALIBRATED 214227070","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":914.74,"discounted_cash":228.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER SKIN INSORB SUBCUTICULAR #2030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":464.22,"discounted_cash":116.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":463.92,"discounted_cash":115.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ENDOLOOP O VICRYL 18IN #EJ1O","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":273.23,"discounted_cash":68.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SURGICAL BEAVER DEBAKEY 4810 #37-4810","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":76.53,"discounted_cash":19.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER EX-FIX TRANSFIX PIN 5X300MM #5050-5-300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1895.2,"discounted_cash":473.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI INSTRUMENT 8MM PERMANENT CAUTERY HOOK 420183","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI INSTRUMENT 8MM PERMANENT CAUTERY SPATULA 420184","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE POSITIONING STAR SLEEVE COMPACT AR-1606C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER ECHELON FLEX 60MM EC60A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2756.8,"discounted_cash":689.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"L-HOOK CAUTERY MEGADYNE 33CM 0020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":393.25,"discounted_cash":98.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE ABC FOOTSWITCHING 10MM 130342","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1170.39,"discounted_cash":292.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT GELFOAM PLUS HEMOSTASIS 1501341","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":991.68,"discounted_cash":247.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTEGRA SHUNT SUNDT INTERNAL CAROTID 3X5MM NL850-5066","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4823.9,"discounted_cash":1205.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE PROBE M5 2012021","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE NEUROVISION M5 EMG MODULE 8050215","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8964.95,"discounted_cash":2241.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 2.9MM 310.229","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":832.34,"discounted_cash":208.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 4-0 30IN SH-1 8526H*DO NOT USE SEE 009714","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":68.50,"discounted_cash":17.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER K-WIRE 2.0X150MM 390192","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL STANDARD 2.7MM 00236020527","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1004.25,"discounted_cash":251.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER AMS GREENLIGHT MOXY 0010-2400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10812.0,"discounted_cash":2703.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT QUICK COUPLE 4.3X300MM 324.213","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1739.36,"discounted_cash":434.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE STRYKER SAW DOUBLE SIDED 0277-096-275","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":259.46,"discounted_cash":64.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE STRYKER SAW DUAL CUT TEETH 2108-107-004S1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":195.19,"discounted_cash":48.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE CRYO-ABLATION ATRICURE ICE 10CM CRYO2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19041.75,"discounted_cash":4760.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BANDAGE ESMARK 6INX9FT STERILE LF","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.63,"discounted_cash":10.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA FEMORAL VENOUS PERCUTANEOUS KIT 25FRX60CM 96880-025","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3996.4,"discounted_cash":999.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT PREVENA 14 DAY MACHINE PRE4010.S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4223.82,"discounted_cash":1055.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MARKER DELIVERY TOOL SDMDK1000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1371.96,"discounted_cash":342.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR WOUND ALEXIS XSMALL 2-4CM INCISION C8312","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":669.5,"discounted_cash":167.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DRILL BIT 2.6MM AR-8943-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET DRILL DISTAL GRADUATED SHORT 4.3MM 2112-01-406","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2115.93,"discounted_cash":528.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON INTRAGASTRIC B-2020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1874.6,"discounted_cash":468.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE FIBERWIRE 5 38IN AR-7210","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":391.4,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCISSOR MICROLINE ENDO DISPOSABLE 3152","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":345.05,"discounted_cash":86.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI MEGA SUTURECUT NEEDLE DRIVER 420309","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLEEVE ETHICON XCEL STABILITY 5MM CB5LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":123.29,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ESTECH VASCULAR DILATOR KIT 200-120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1191.71,"discounted_cash":297.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI S FORCEPS PROGRASP #420093","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":566.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FLOSEAL SPECIAL APPLICATOR TIPS ADS201816","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":208.78,"discounted_cash":52.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI S NEEDLE DRIVER LARGE 420006","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":566.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCISSORS ROUND TIP DAVINCI 420007","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE MARTIN UTERINE 1/2 CIRCLE CUTTING EDGE 1860-4D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36.57,"discounted_cash":9.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN BLAKE HUBLESS SILICONE 10FR 2226","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":884.15,"discounted_cash":221.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACK PERFUSION HEMOCONCENTRATOR H700 W/BAG 020121801","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":691.75,"discounted_cash":172.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER ECHELON FLEX 45 ROTICULATING EC45A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2475.5,"discounted_cash":618.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY PEAK PLASMABLADE 3.0S PS210-030S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2940.44,"discounted_cash":735.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SURGIFOAM SPONGE ABSORB PORCINE GELATIN L12.5X W8 CM X2 1975","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":362.66,"discounted_cash":90.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":362.66,"discounted_cash":90.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT K-WIRE 1.4MM (0.062 INCH) 500036","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 22FR LATEX 5CC 3-WAY 2722","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":103.93,"discounted_cash":25.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLES ENDO GIA 45MM XTRA THICK RELOAD BLACK SIG45AXT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4306.12,"discounted_cash":1076.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DURASEAL DURAL SEALANT SYSTEM 5ML 202050","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5856.5,"discounted_cash":1464.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE 21GA EXCELON TRANSBRONCH ASPIRATION W/20CC SYR/130CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":805.46,"discounted_cash":201.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VLOC 180 0 12INCH GS-21 GREEN VLOCL0316","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":240.20,"discounted_cash":60.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":240.2,"discounted_cash":60.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE STERNOTOMY DOUBLEWIRE USP6 3X14IN 046-297","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1115.8,"discounted_cash":278.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR DILATOR AND CANNULA VERSASTEP 15MM VS101015P","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 0 30IN GRN BRD SH #X834H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.86,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.86,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 3-0 SH-1 48IN 8534H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.13,"discounted_cash":10.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STAINLESS STEEL 18GA DS18","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":50.37,"discounted_cash":12.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTOR SURGICAL CUT EDGE XTRACT-ALL BROKEN SCREW LONG 6IN 5MM SXT006","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3759.5,"discounted_cash":939.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AGENT HEMOSTATIC FLOSEAL MATRIX RECOTHROM ADS202105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1470.94,"discounted_cash":367.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALANT HEMOSTATIC VISTASEAL FIBRIN 4ML VST04","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3056.11,"discounted_cash":764.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALANT TISSUE CLOSURE VISTASEAL FIBRIN 10ML VST10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6148.87,"discounted_cash":1537.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MIDAS REX MR8 CUTTER 9CM 3MM MR8-9MC30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2654.83,"discounted_cash":663.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOSTAT SURGICEL SNOW NONWOVEN ABSORBABLE 4X4IN 2083","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2000.47,"discounted_cash":500.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2000.46,"discounted_cash":500.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRENCH TORQUE CUSA CLARITY DISP 36KHZ C7602EA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1134.65,"discounted_cash":283.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PROLENE EVERPOINT MONOFILAMENT BLUE 6-0 C-1 24IN EP8726H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":142.29,"discounted_cash":35.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA PERFUSION OPTISITE AXILLARY AORTA 22FR 24CM 3/8IN OPTI22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2708.59,"discounted_cash":677.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PROLENE 2 ARM MONOFILAMENT BLUE 5-0 RB-1 30IN HS6856H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":104.55,"discounted_cash":26.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STABILIZER SURGICAL ACROBAT-1 OM-10000Z","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9782.16,"discounted_cash":2445.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MIDAS MR8 9CM 25.4MM MR8-9MC254","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2211.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL 4.3X413MM 03.168.011","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM FLUID MANAGEMENT SYMPHION FG-0202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4109.7,"discounted_cash":1027.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE TISSUE REMOVAL SYMPHION RESECT 3.6MM FG-0201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9000.99,"discounted_cash":2250.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE VACUUM EXTRACTION TUBE COLLECTION SET HANDLE AND ADAPTER 6FT 3/8IN 022310","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":120.30,"discounted_cash":30.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE SURGICAL FLEXIBLE 9MM 022009","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM FLEXIBLE 6MM 022006","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM FLEXIBLE 7MM 022007","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEARS SURGICAL HARMONIC 20CM HAR1120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4791.01,"discounted_cash":1197.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM FLEXIBLE 10MM 022010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PROLENE MONOFILAMENT BLUE 5-0 C-1 24IN EPH8725H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":225.67,"discounted_cash":56.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SURGIFLO APPLICATOR ENDO 34CM MS1995","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":186.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POWERED STAPLER ECHELON CIRCULAR 31MM CDH31P","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3583.92,"discounted_cash":895.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL CANN 2.7MM 03.333.102","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5679.18,"discounted_cash":1419.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ASPIRATOR SONOPET IQ LARGE TIP 12CM 5500-25S-308","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6680.73,"discounted_cash":1670.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 0 UR-6 BRAID ANTIBACTERIAL COATED VIOLET 27IN VCP603H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.58,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLICATOR ENDOSCOPIC SURGICEL 73.6OZ 3123SPEA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":328.01,"discounted_cash":82.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER EPISTAXIS EPISTAT SILICONE NASAL BEVELED TIP 1527031","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":831.62,"discounted_cash":207.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE ETHIBOND EXCEL 2 CT-1 36IN D9420","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":468.33,"discounted_cash":117.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL MO-5 VIOLET 18IN J801D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":119.79,"discounted_cash":29.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER POWER STANDARD 3000 ECHELON 60X340MM EC3D60S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4275.8,"discounted_cash":1068.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL CALIBRATION QUICK COUPLING 2X30X110MM 03.133.100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1312.84,"discounted_cash":328.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL TWIST 1.6 X 30MM A-3434","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1184.5,"discounted_cash":296.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN NAVIGATION 4.0X110MM OC910.110.040-2P","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":399.13,"discounted_cash":99.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN NAVIGATION 4.0X140MM HTS-2P-44140","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":399.13,"discounted_cash":99.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE GORE-TEX 36IN 0N05A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":365.65,"discounted_cash":91.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL CANN 3/16IN SQUARE 4.6X7X220MM P99-110-4622","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1871.51,"discounted_cash":467.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE ELECTROSURGICAL PLASMABLADE 3.0S LIGHT PS210-030S-LIGHT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3079.7,"discounted_cash":769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL ECHELON CONTOUR TI CURVE CUTTER 40MM GCS40G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2953.53,"discounted_cash":738.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER POWER ECHELON 3000 LONG 45MM ECH45L","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3515.46,"discounted_cash":878.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER POWER ECHELON 3000 COMPACT 45X45X280MM ECH45C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3515.49,"discounted_cash":878.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER POWER ECHELON 3000 COMPACT 60X60X280MM EC3D60C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4115.26,"discounted_cash":1028.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CLEAR ABSORBABLE MONOFILAMENT 2-0 27IN D9603","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":422.09,"discounted_cash":105.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AGENT HEMOSTATIC SURGIFLO THROMBIN 8ML KIT 2994","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2490.23,"discounted_cash":622.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE SURGICAL FLEXIBLE 11MM 022011","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEAL CANNULA 5-12MM 470500","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE BIZACT TONSIL BIPOLAR TISSUE SEAL DIVIDER  12MM BZ4212A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2858.97,"discounted_cash":714.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL CARBIDE MICRO TAPER CROSSCUT FISSURE 2.1X7X45MM 0277-010-421","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":70.25,"discounted_cash":17.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD REAMING BALL TIP 2.5X950MM 351.706S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1139.19,"discounted_cash":284.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1103.13,"discounted_cash":275.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL 3 FLUTE QUICK COUPLING NEEDLE POINT 3.2X145MM 03.010.103S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2018.59,"discounted_cash":504.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBERTAK INSTRUMENT GUIDE KIT 2.6MM AR-3710","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2523.5,"discounted_cash":630.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER SURGICAL INBONE END CUT 14MM 22001400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8343.26,"discounted_cash":2085.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER SURGICAL INBONE END CUT 12MM 22001200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8343.26,"discounted_cash":2085.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR LAPAROSCOPIC VERSAONE W/DUAL FIXATION CANNULA STANDARD 5X150MM ONB5STF2C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":768.79,"discounted_cash":192.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH URETHRAL HEMATURIA COUDE 22FR 30CC 3 WAY #2557H22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":146.98,"discounted_cash":36.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PERMA-HAND SILK 4-0 BRAID BLACK 18IN N272H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.10,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MR8 ACORN 9CM 7.5MM MR8-9AC75","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1824.75,"discounted_cash":456.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER SOLTIVE SCOPE BEND RADIUS 150 UM TFL-FBX150S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2997.3,"discounted_cash":749.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER SOLTIVE THULIUM 365 UM TFL-FBX365S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2997.3,"discounted_cash":749.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER 200 UM TFL-FBX200S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2997.3,"discounted_cash":749.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER SOLTIVE THULIUM 940 UM TFL-FBX940S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA VERSAONE STANDARD UNIVERSAL FIXATION 5X100MM UNVCA5STF","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":195.08,"discounted_cash":48.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUTTLE SUTURE FIBERTAPE 2MM 48INCH AR-7268","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4892.5,"discounted_cash":1223.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE MEGADYNE E-Z CLEAN PTFE L-WIRE 5MM 33CM 0100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":393.2,"discounted_cash":98.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM RIGID PLASTIC CURVED 6MM 022106","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS ANTIBACTERIAL BRAID COATED UNDYED 4-0 SH 27IN VCP415H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.84,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE CURVE LATERAL BEVEL EDGE 11CM 12MM SBLDCURVE-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":952.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM RIGID CURVED 7MM 022107","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM RIGID CURVED 8MM 022108","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM RIGID CURVED 9MM 022109","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM RIGID CURVED 10MM 022110","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM RIGID CURVED 11MM 022111","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM RIGID CURVED 12MM 022112","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CURETTE VACUUM RIGID CURVED SMALL 14MM 3/8IN BASE 022145","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":54.38,"discounted_cash":13.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL 3 FLUTE QUICK COUPLING 3.2X230MM 315.93","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3064.36,"discounted_cash":766.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT SHORT FLUTED 2.0MM AR-18800-18","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":412.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL FREEHAND 4.2X130MM 2351-4213S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2441.1,"discounted_cash":610.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 0 CT-1 BRAID ANTIBACTERIAL COATED UNDYED 36IN VCP946H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.21,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 4-0 VIOLET SH 27IN #MCP315H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.3,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.66,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":17.30,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 2-0 CT-1 18IN VCP839D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":93.22,"discounted_cash":23.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS CTX BRAID ANTIBACTERIAL COATED UNDYED 36IN VCP977H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.35,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL MATCH HEAD NEURO SOFT TOUCH 2X3.1MM 5820-107-020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1220.24,"discounted_cash":305.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE FLEXIBLE SYSTEM S7BLADE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11262.5,"discounted_cash":2815.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE FLAT 11CM 8MM SBLDFLAT-2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":952.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE CURVED LATERAL 16CM 12MM SBLDCURVE-2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":952.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE CURVE MEDIAL 16CM 12MM SBLDCURVE-4","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":952.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE CALCAR BEVEL EDGE 3CM 8MM SBLDCALC-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":952.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 2-0 CT-1 BRAID ANTIBACTERIAL COATED UNDYED 36IN VCP945H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.73,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS MP 5-0 CLR 18IN P-3 #PDP493","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":43.26,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL ECHELON FLEX ENDOPATH 45MM EC45A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2657.92,"discounted_cash":664.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE ETHILON MULTIPASS 5-0 P-3 18IN 698G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.98,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ENDOSCOPY SUCTION IRRIGATOR W/TIP 250-070-520","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":534.65,"discounted_cash":133.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":534.78,"discounted_cash":133.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":533.52,"discounted_cash":133.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":534.78,"discounted_cash":133.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE MARTIN 1/2 CUTTING SZ 4  216404","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":63.76,"discounted_cash":15.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 2-0 60IN BLK MONO TP-1 #825G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.68,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 2-0 27 INCH VIOLET SH #VCP317H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.38,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13.35,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13.39,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 3-0 27 INCH VIOLET SH #VCP316H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.49,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13.48,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13.47,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTOR STONE NCIRCLE TIPLESS 3FR 115CM G17627","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2460.46,"discounted_cash":615.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR BLADELESS ENDOPATH XCEL 15MM B15LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":308.23,"discounted_cash":77.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ENDOSCOPY BURR BARREL 5MM 6FLUTE HOLLOW 375-951-100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ROLLERBALL 24FR 5MM  6/12","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1010.74,"discounted_cash":252.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1010.73,"discounted_cash":252.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTOR STONE NITINOL NCOMPASS 2.4FR 115CM G32702","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3799.67,"discounted_cash":949.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOOPS SILICONE MINI YELLOW 1.5X.88MM 3/32\"","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE NEEDLE TIP  COATED 2.8INCH PTFE INSULATED","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":33.17,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 3-0 18IN UNDYED PS-2 MCP497G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.73,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":41.82,"discounted_cash":10.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 4-0 18 UD PS-2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":38.73,"discounted_cash":9.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":43.23,"discounted_cash":10.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":43.26,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":43.22,"discounted_cash":10.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS UD 5-0 18 P-3 #MCP493G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":46.14,"discounted_cash":11.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":46.08,"discounted_cash":11.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA VENOUS MC2 TWO STAGE 29/29FR 91329","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":356.17,"discounted_cash":89.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTOR STONE NCIRCLE DELTA WIRE TIPLESS 2.4F 115CM G19110","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3320.72,"discounted_cash":830.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SUBDERMAL RHYTHMLINK 121.1.5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":44.81,"discounted_cash":11.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR LAPAROSCOPIC ENDOPATH XCEL L150 MM OD5 MM B5XT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.13,"discounted_cash":44.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR VERSAPORT V2 5mm W/FIXATION CANNULA #179094F","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":195.7,"discounted_cash":48.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLOSURE SYSTEM CARTER-THOMPSON #75926","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":733.67,"discounted_cash":183.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":755.33,"discounted_cash":188.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR LAPAROSCOPIC BLADELESS ENDOPATH 100X5MM 2B5LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.13,"discounted_cash":44.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE CUTTING THIN LOOP 24FR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1010.74,"discounted_cash":252.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1010.73,"discounted_cash":252.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOUND VAC DRESSING GRANUFOAM EXTRA LARGE M8275065/5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":930.81,"discounted_cash":232.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT CAROTID OUTLYING 9FR X 31cm","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7919.79,"discounted_cash":1979.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT INTRACORONARY 1.5MM 31150","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":646.84,"discounted_cash":161.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT INTRACORONARY 2.5MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":646.84,"discounted_cash":161.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT INTRACORONARY 2MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":646.84,"discounted_cash":161.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUCTION TUBE CARDIAC DLP 6FR W/10FR SOFT TIP 10052","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":144.92,"discounted_cash":36.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE PACING EXTENSION SCREW-DOWN BEIGE FL-601-97","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRENCH KIT TORQUE HEXAGONAL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE SUBDERMAL PAIRED XOMED 82-27410","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1042.57,"discounted_cash":260.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 2.8 X 165MM QUICK COUPLE 310.288","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":834.61,"discounted_cash":208.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES K-WIRE TROCAR POINT 1.6 X 150MM 15MM THRD 292.71","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.40,"discounted_cash":38.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOCLIP LARGE LIGATING TITANIUM HORIZON 24CLIP/PK  #004204","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":213.10,"discounted_cash":53.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":214.24,"discounted_cash":53.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOCLIP MEDIUM LIGATING HORIZON 24 CLIP/PK  #002204","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":105.38,"discounted_cash":26.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":105.29,"discounted_cash":26.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":104.71,"discounted_cash":26.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":104.37,"discounted_cash":26.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOCLIP  MED/LG  LIGATING GREEN  #003200. 12/22/15CN EA=PK. 20PK/BX.  THESE DO NOT GET ISSUED BY EACH CLIP AS THEY ARE A SINGLE STERILE PK. THEREFORE PK=1. DO NOT CHANGE PUM.","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":34.94,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":35.02,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOCLIP SMALL LIGATING HORIZON 24 CLIP/PK  W1204W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":83.12,"discounted_cash":20.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":83.13,"discounted_cash":20.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":82.66,"discounted_cash":20.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":83.22,"discounted_cash":20.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR VERSASTEP REPOSABLE 12mm #VSR101012","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3040.46,"discounted_cash":760.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL QUICK COUPLING 2.5X180MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":751.08,"discounted_cash":187.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT 1.8MM W/DEPTH MARKINGS 110MM 310.509","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1384.42,"discounted_cash":346.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES GUIDE WIRE DRILL TIP 2.5 X 200MM 310.243","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":666.98,"discounted_cash":166.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":601.72,"discounted_cash":150.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOOPS SILICONE RED 2.5MM 1001-76","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.38,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSERTS NOVARE INTRACK CLAMP 45MM STD/TRACTION N-10171","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":277.07,"discounted_cash":69.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOOPS SILICONE BLUE 2.5MM 1001-78","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.45,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.38,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 2-0 27IN COATED VIO BRD UR-5 J375H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE KIT BIOPSY #9733068","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY IRRIGATION 3-WAY 22FR LATEX #0167SI22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":25.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE KIT TRAJECTORY EXTERNAL BIOPSY #9733065","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14154.71,"discounted_cash":3538.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OCCLUDER COLPO-PNEUMO","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":566.05,"discounted_cash":141.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALER AQUAMANTYS 6.0 BIPOLAR 23-112-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3553.5,"discounted_cash":888.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA VENOUS SINGLE STAGE 24FR 66124","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":264.61,"discounted_cash":66.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR CATHETER URETERAL LATEX FREE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAGITTAL 6 SYSTEM 25 X 90 1.19MM 6125-119-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":479.05,"discounted_cash":119.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 1 36IN CT-1 #VCP347H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAGITTAL 6 SYSTEM 13 X 90 1.19MM 6113-119-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":494.71,"discounted_cash":123.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 3FLUTE NEEDLE POINT 4.2X145MM 03.010.104","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1636.97,"discounted_cash":409.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1572.19,"discounted_cash":393.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA RETROGRADE 15FR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":834.51,"discounted_cash":208.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SUCTION  LEFT HEART VENT 16FR MEDTRONIC 12016","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":223.92,"discounted_cash":55.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STEEL 6 4X18 CCS HRS-48 M654G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":111.45,"discounted_cash":27.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY  SUCTION HAND CONTROL 8FR 6 INCH #E26086","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":76.12,"discounted_cash":19.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER POWER ECHELON STANDARD 3000 45MM ECH45S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3582.44,"discounted_cash":895.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER POWER ECHELON LONG 3000 60MM EC3D60L","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4138.13,"discounted_cash":1034.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL XLONG 4.2MM 03.045.022","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3068.81,"discounted_cash":767.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE PERSONA HEX 3.5X48MM 00590103548","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT 4.2 X 100MM 3 FLUTED 03.010.061","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2205.23,"discounted_cash":551.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 4-0 27\" UNDYED FS-1 J441","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.82,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 2-0 27\" CT-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.66,"discounted_cash":5.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 2-0 36 INCH VIOLET CT-1 #VCP345H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.32,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":14.06,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 5-0 30IN RB-2 DA #PDP148H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER ENDO 33MM SINGLE USE EEA33","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 24IN DBL ARM*DO NOT USE SEE 046260","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":135.55,"discounted_cash":33.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KNIFE COLD ROUND DISPOSABLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1577.45,"discounted_cash":394.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ROLLER BALL 27FR 5mm #27050MK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1010.22,"discounted_cash":252.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NOVARE INSERT 66MM N-10126","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":265.23,"discounted_cash":66.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TORQUE DEVICE GUIDWIRE ACCESSORY 0.010-0.038IN WIRES TD01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.18,"discounted_cash":15.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEP CUP BIOPSY 3FR X 115CM W/OVAL HEAD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4217.85,"discounted_cash":1054.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE SAGITTAL 1.27MMX100MM NARROW LONG 6118-127-100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":494.71,"discounted_cash":123.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 3-0 27IN VIO MONO RB-1 Y305H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 3-0 27IN UND MONO RB-1 Y215H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.17,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA AORTIC ROOT 7FR STD TIP FLOW-GUARD INTRODUCER 11014","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":167.89,"discounted_cash":41.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 0 BLK BRD 8-18IN CT-1 C021D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUMP PERICARDIAL 15 INCH W/1/8 INCH TIP 12012","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":127.21,"discounted_cash":31.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CLIP ENDO LAPRA-TY ABSORBABLE XC200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":568.27,"discounted_cash":142.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 0 27IN VIOLET CT-2 J334H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 0 36 INCH VIOLET CTX #VCP370H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.83,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PLAIN GUT 3-0 27\" CT-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.97,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 1 36IN CTX #VCP371H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 0 8X18\" VIOLET MO-4 J701D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":116.08,"discounted_cash":29.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 3-0 36 INCH VIOLET CT-1 #VCP344H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.52,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":14.24,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PERMA-HAND SILK 4-0 RB-1 BLACK 30IN K871H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM BORDER SACRUM 7IN X 7IN #MSCEX77EP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":59.53,"discounted_cash":14.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOSTAT SURGICEL REGENERATED CELLULOSE POWDER 3013SP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3114.62,"discounted_cash":778.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":3114.62,"discounted_cash":778.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM BORDER SACRUM 9INX9IN #MSCEX99EP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":92.91,"discounted_cash":23.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":92.90,"discounted_cash":23.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":92.92,"discounted_cash":23.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 0 CT-2 27IN VCP270H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.01,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE ETHILON BLACK 3-0 PSL 30IN 1691H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FOCAL PAK DISPOSABLE KIT 901400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18414.0,"discounted_cash":4603.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ELECTROSURGICAL BALL COAGULATE 27FR 5MM 27050MK-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1010.74,"discounted_cash":252.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACK SURGICAL CONVERTORS UNIVERSAL 90X44IN 29118","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":153.16,"discounted_cash":38.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIXATION KIRSCHNER 1 END TROCAR POINT SMOOTH PLAIN .045X9IN KM172-19-45","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.48,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING NASAL NASOPORE FIRM 4CM 5400-020-004","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1804.87,"discounted_cash":451.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WAND ELECTROSURGICAL HALO DISP 72290134","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3716.14,"discounted_cash":929.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MR8 DIAMOND LONG BALL COARSE GRIT 7CM 1MM MR8-7BA10DCL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2211.0,"discounted_cash":552.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MR8 DIAMOND LONG BALL COARSE GRIT 7CM 2MM MR8-7BA20DCL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2320.49,"discounted_cash":580.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE CHROMIC 2-0 CT-2 MONOFILAMENT BROWN 27IN 883H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER MEMORYGEL MODERATE CLASSIC PROFILE ROUND 385MM RSZ-7385MCS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3141.5,"discounted_cash":785.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM SURGICAL OMNI 1-108","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13505.99,"discounted_cash":3376.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE DERMATOME PADGETT DISP 3539-252","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1087.68,"discounted_cash":271.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORABLE STRATAFIX MONOCRYL PLUS 4-0 PS-2 SPIRAL UNDYED 45CM SXMP1B118","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":277.98,"discounted_cash":69.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE SUCTION IRRIGATION HYDRODEBRIDER STANDARD 1914001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3527.44,"discounted_cash":881.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEARS HARMONIC 700 ADVANCE 23CM HAR723","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3685.55,"discounted_cash":921.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM AG 4X4IN #MSC9544EP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":95.79,"discounted_cash":23.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM BORDER 4X4IN MSCEX44EP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":26.49,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":26.47,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":26.51,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":26.48,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM BORDER 6X6IN #MSCEX66EP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":55.21,"discounted_cash":13.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":55.20,"discounted_cash":13.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":55.22,"discounted_cash":13.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING AQUACEL AG 6X6IN 422298","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":153.16,"discounted_cash":38.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":148.61,"discounted_cash":37.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":131.02,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":143.32,"discounted_cash":35.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM MEPILEX BORDER AG 4X6IN 498300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":220.73,"discounted_cash":55.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING MEPITEL AG SILVER 4X5IN 390090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":150.17,"discounted_cash":37.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM NEGATIVE PRESSURE PICO 20X20CM 66022008","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2492.6,"discounted_cash":623.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING WOUND URGOCLEAN AG 4X5IN 603071","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":104.85,"discounted_cash":26.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING ALGINATE 4X4IN #MSC7344EP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.46,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":22.45,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING WOUND URGOCLEAN AG 6X8IN 603073","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":235.97,"discounted_cash":58.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE PERCUTANEOUS ECHO TIP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.2,"discounted_cash":10.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE KIT ECHO-ENHAN 7CM NEEDLE 5FR 10CM MAK501N-E","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":193.23,"discounted_cash":48.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS GRASPING TOOTH RAT 230CM M00538351","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE INFLATION EVEREST 30 DISP AC3200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":391.4,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING ENDOFORM 4x5 FENESTRATED 529314","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":369.36,"discounted_cash":92.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING ENDOFORM 2x2 FENESTRATED HL529312","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":106.09,"discounted_cash":26.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN INCISION JACKSON-PRATT FLAT FULL FLUTE CHANNEL TROCAR 15FR 10MM JP-2215","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":212.28,"discounted_cash":53.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS OPHTHALMIC HANDS FREE GONIOSCOPY K30-1407","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":440.84,"discounted_cash":110.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS CONTACT AIR OPTIX NIGHT & DAY AQUA 8.4X13.8MM +0.50D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":118.36,"discounted_cash":29.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR LEGEND DIAMOND XCOARSE BALL HEAD 6MM 7.5CM 75BA60DX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":870.97,"discounted_cash":217.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MR8 DIAMOND BALL XCOARSE GRIT 4MM 7CM MR8-7BA40DX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1146.6,"discounted_cash":286.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TIP SUCTION STANDARD MALLEABLE 9FR 9735016","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3216.38,"discounted_cash":804.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AGENT PERCLOT POWDER STANDARD APPLICATOR TIP 3GM 9CM PCUS003","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1540.67,"discounted_cash":385.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AGENT PERCLOT STANDARD TIP 9CM 1GM PCUS001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1049.46,"discounted_cash":262.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR ONETRAC LX 30X90MM SNGL USE C100280","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2317.5,"discounted_cash":579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING MEPILEX FOAM SELF ADHERENT 6 X 6","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":48.82,"discounted_cash":12.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING WOUND HONEY 4 X 5IN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":86.73,"discounted_cash":21.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BANDAGE SYSTEM COMPRESSION 3 LAYER MSC4300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":106.91,"discounted_cash":26.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING WOUND CONTACT 4X7 #MSC1847EP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":82.4,"discounted_cash":20.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL 10-0 CS160-6 MONOFILAMENT COATED VIOLET 12IN V448G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.57,"discounted_cash":44.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OPHTHALMIC INTREPID IRRIGATION ASPIRATION BIMANUAL HANDPIECE SET 8065751922","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":189.01,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER IMPLANT MEMORYGEL BOOST MOD PROFILE GEL SMOOTH 530CC RSZ-MPB-530S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3399.0,"discounted_cash":849.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE CUTTING LOOP 27FR #27050F-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1010.74,"discounted_cash":252.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC CARTRIDGE MONARCH III B 8065977758","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPLINT MEDTRONIC THERMASPLINT SINGLES MEDIUM 1529010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":177.68,"discounted_cash":44.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY BLADE PEAK PLASMA 4.0 PS200-040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2695.82,"discounted_cash":673.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MANIPULATOR UTERINE CONMED V-CARE MEDIUM 60-6085-201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":509.03,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KNIFE OPHTHALMIC 15DEGREE 8065921502","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":52.94,"discounted_cash":13.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE MICRO STRAIGHT FINE/OFFSET 2296-3-194","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.36,"discounted_cash":54.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR BLADELESS ENDOPATH XCEL RIBBED 11X100MM B11LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.13,"discounted_cash":44.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCISSORS CURVED WITH MONPOLAR CAUTERY 5MM DISP #5DCS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":399.74,"discounted_cash":99.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK BLACKK BRAID 3-0 18IN 12 STRAND A184H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.26,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER ENDOSCOPIC M-CLIP W/ROTATE SHAFT 20MED/LG #ER320","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":567.43,"discounted_cash":141.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS II VIOLET MONO ENDOLOOP 0 18 #EZ10G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":276.04,"discounted_cash":69.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL 0 27IN UR-6 ETVCP603H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.35,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE PNEUMOPERITONEUM DISP PN120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":92.7,"discounted_cash":23.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RESERVOIR CLOSED WOUND SUCTION 100CC 0070740","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":37.60,"discounted_cash":9.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYCL PLUS 2-0 VIOLET 27IN UR6 #MCP605H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18.85,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE POLYSORB 2-0 30 (X5) V-20 VIOLET #GL-66-M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":52.63,"discounted_cash":13.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SURGITIE LG LP POLYSORB 0","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":870.70,"discounted_cash":217.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING EAR GLASSCOCK ADULT 5.5IN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":183.13,"discounted_cash":45.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL 6-0 S-14 ARM BRAID VIOLET 18IN J570G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":110.29,"discounted_cash":27.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 10 0 12IN BLACK TG160-6 #9000G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":128.54,"discounted_cash":32.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BANDAGE ESMARK 4 X 3 STERILE LF","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.22,"discounted_cash":10.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"URODRAIN DRAIN BAG #335563","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":30.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE ENDOTRACHEAL NIM EMG 7MM 8229307","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3725.82,"discounted_cash":931.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING NASAL/OTOLOGIC STENT MEROGEL 15-17000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1126.82,"discounted_cash":281.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE ETHMOID XPS STRAIGHTSHOT TRICUT 3.5MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2004.38,"discounted_cash":501.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE SALEM SUMP 16 FR W/GIENTRI PORT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.51,"discounted_cash":18.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CYSTOTOME IRRIGATING FORMED REVERSE CUT 25GA#8065-4251-20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36.87,"discounted_cash":9.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE HOLDER NG DISPOSABLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":4.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO JAW DISPOSABLE BIOPSY FORCEPS FB-220U.A (N5355430)","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":63.63,"discounted_cash":15.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":63.86,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO CLIP APPLIER 10MM DISPOSABLE #176657.","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2652.77,"discounted_cash":663.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP LIGATING LIGACLIP MED/LG LT300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":34.20,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE ECHOTIP BIOPSY PROCORE 7.95FR G34785","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3450.5,"discounted_cash":862.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE ECHOTIP HD BIOPSY 19GA 5.2-4.2FR G52012","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3440.2,"discounted_cash":860.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS BIOPSY HOT JAW 4 RADIAL M00515032","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":242.05,"discounted_cash":60.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE CAPTIVATOR SINGLE USE STD OVAL 27MM WIDE 240CM LONG","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RADIAL JAW 4 BIOPSY PEDI FORCEP W/NDLE 1.8 X 160CM M00513450","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":302.82,"discounted_cash":75.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MARKER GI SPOT-EX INJECTION PREFILLED STERILE GIS-45","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":355.35,"discounted_cash":88.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS ENDOJAW ALLIGATOR CUP W/NEEDLES FB-220K.A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS RESCUE RAT TOOTH JAW PEDI 1.8-180CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE EXACTO COLD POLYPECTOMY 2.4X230 BX00711115","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPECIMEN RETRIEVAL POLY TRAP 00711099","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAPTIVATOR COLD THIN WIRE SINGLE USE SNARE 10mm  M00561101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":175.1,"discounted_cash":43.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAPTIVATOR SINGLE USE 10mm POLYPECTOMY SNARE M00561221","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP INTERNAL RESOLUTION 360 235cm x 2.8mm M00521230","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2461.7,"discounted_cash":615.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS BIOPSY RADIAL JAW 4 2.8mm M00513410","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE EZ SHOT ASPIRATION SINGLE USE 25G NA-U200H-8025","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2966.4,"discounted_cash":741.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NET STANDARD RETRIEVAL LOOP 230/2.5/OV 30X60 MED-217-NET","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COOK ECHOTIP HD ULTRASOUND BIOPSY NEEDLE HD-25-C G55738","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3450.5,"discounted_cash":862.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PARACENTESIS SAFE-T-CENTESIS TRAY 6F","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":474.11,"discounted_cash":118.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY URINEMETER 14FR LATEX FREE SURESTEP A902214","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":254.72,"discounted_cash":63.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETHRAL ROBINSON RED RUBBER 14FR 87-660143","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ONMICUP KIWI WITH TRACTION FORCE INDICATOR VAC-6000MT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":294.68,"discounted_cash":73.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARISTA 1 GRAM SM0005USA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1085.62,"discounted_cash":271.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOSTATIC POWDER ARISTA AH 3 GRAM SM0002USA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2164.03,"discounted_cash":541.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INTRAUTERINE PRESSURE KOALA BALLOON SENSOR TIP IPC-5000E","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":288.4,"discounted_cash":72.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"JADA SYSTEM DEVICE INTRAUTERINE VACUUM JADA-2002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12163.5,"discounted_cash":3040.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FOLEY CATHETER STABILIZATION STATLOCK DEVICE 3-WAY FOL0105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":27.6,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":27.60,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CATHETER FOLEY 350ML URINE METER  #901816","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.88,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR O 36IN CT-1 #J946H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.18,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FETAL SCALP ELECTRODE CABLE KENDALL FOR PHILIPS MONITORS 8FT LVMPM004-MD-R","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1055.85,"discounted_cash":263.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAYFIX FIXATION DEVICE FOR PERCUTANEOUS CATHETERS 680ME","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":76.63,"discounted_cash":19.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY CATHETER INTERMITTENT LATEX FREE 16FR INTS16","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":64.89,"discounted_cash":16.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIPPING DEVICE 2.8MMX4.2MMX230CM INSC-P-7-230-S G58010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE ACUJECT FLEX INJECTION 25GA 230CMX2.8MM G57784","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPECIMEN RETRIEVAL ROTATABLE 230X6X3CM 2.5X2.8MM G57798","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1009.4,"discounted_cash":252.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDOCLOT POLYSACCHARIDE HEMOSTATIC 3GM 230X2.8CM EPK2303-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11172.4,"discounted_cash":2793.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIFTER SURGICAL EVERLIFT 5ML GIS-55","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":103.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGATOR ENDO UNIVERSAL SAEED 6 SHOOTER 8.6-11.3X122CM G31917","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2626.5,"discounted_cash":656.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE BIOPSY ACQUIRE S FRANSEEN ULTRASOUND FINE NEEDLE TAPER POINT 25GA M00555660","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4068.5,"discounted_cash":1017.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOSTAT ABSORBABLE PURASTAT 3ML 621-062","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6081.75,"discounted_cash":1520.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADAPTER SYRINGE PURASTAT 001-099","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PURASTAT CATHETER WP-18/2200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":143.69,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS CAPTURA PRO STANDARD 2.2MM 230CM G47693","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":100.43,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP APPLIER ENDO 5mm W/TITANIUM CLIPS #176620","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3577.09,"discounted_cash":894.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOCLIP RETENTION 9MM SCA-23-230-09","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BIOPSY CHIBA 18GA 10CML DISPOSABLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":123.09,"discounted_cash":30.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BIOPSY CHIBA 18GA 15CM DISPOSABLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":123.81,"discounted_cash":30.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE ARGON PLASMA 2.3MM/7FR X 22Ocm LENGTH #20132156","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7162.95,"discounted_cash":1790.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ALLIANCE II INFLATION SYS SYRINGE-GAUGE ASSMB M00550601 5060","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":300.76,"discounted_cash":75.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP HEMOLOK MEDIUM/LARGE GREEN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":326.2,"discounted_cash":81.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE EUS ECHO-TIP 25 G31519","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2430.8,"discounted_cash":607.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIAPC SIDE FIRE PROBE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER CLIP ENDO MULTIPLE W/ROTATING SHAFT 5MM #EL5MLA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":654.98,"discounted_cash":163.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER CLIP ENDO III W/HEMO CLIP 5MM SINGLE USE #176630","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3315.98,"discounted_cash":829.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEP BIOPSY RADIAL JW III W/O NDL 1.8MMX100CM L #1523","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":206.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LINEAR EVS BALLOON MAJ-249","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":213.21,"discounted_cash":53.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEP BIOPSY RAD JAW4 W/NEEDLE 240CM JUMBO #M00513371","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":272.95,"discounted_cash":68.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE 25GA INTERJECT CONTRAST SCLEROTHERAPY 4IN #M00518161","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":298.7,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RADIAL JAW 4 SC 240CM W/NDL M00513410","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.1,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INJECTION GOLD PROBE 10F ELECTROHEMOSTATASIS M00560160","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2037.34,"discounted_cash":509.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ENDO CAPTIVATOR HEXAGON L240 CM X W27 MM OD2.4 M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ENDO CAPTIVATOR SMALL HEXAGON M00562450 OD2.4 M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TWISTER PLUS ROTATABLE RETRIEVAL DEVICE 26MM DGN-538-5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":437.75,"discounted_cash":109.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE SALEM SUMP 12 FR W/GIENTRI PORT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.51,"discounted_cash":18.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE CAPTIVATOR OVAL MICROBIOLOGY","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ELECTROHEMOSTASIS/INJECTION GOLD PROBE 7FR #6015","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2037.34,"discounted_cash":509.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE PLAIN 3-0 CT MONOFILAMENT YELLOWISH TAN 27IN 852H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE CHROMIC 0 MONOFILAMENT BROWN CT-2 27IN 884H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 3-0 27IN UND MONO SH","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 3-0 ETHICON 982H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":46.24,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 0 ETHICON VCP340H 27\" CT-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.60,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13.34,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13.59,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS II 0 8-18IN VIO MONO CT-1 Z740D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":141.83,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DERMABOND PRINEO SKIN CLOSURE SYSTEM CLR602US","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1126.31,"discounted_cash":281.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PLAIN 3-0 30IN FS-2 #H822","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SOLUTION IRRIGATION NACL 1000ml BOTTLE #2F7124","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":33.27,"discounted_cash":8.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL VIOLET 0 COATED BR 36IN CTX J978H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 4-0 UNDYED 27IN P-1 Y935H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":41.82,"discounted_cash":10.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY BARDEX SILICONE 16FR 30CC 166816","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.02,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 4-0 27IN UNDYED PS-1 MCP935H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":45.12,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT URO 1 27IN UND MONO BP 48T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.72,"discounted_cash":18.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PLAIN GUT 0 54IN G-205 S104H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":33.48,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 24FR 30CC LATEX #0166SI24","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":66.02,"discounted_cash":16.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR COONS 18F X 20CM .038-COOK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SWITCH FLOW","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ST ENDO 6F SIM 1 100CM 2SH","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":203.43,"discounted_cash":50.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAINAGE BAG 600CC PVC CLEAR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":97.85,"discounted_cash":24.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":97.67,"discounted_cash":24.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON RETRIEVAL MULTI-3V EXTRACTION 5.5-7FR 190CM 20MM B-V433P-A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1163.9,"discounted_cash":290.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON RETRIEVAL MULTI-3V EXTRACTION 5.5-7FR 190CM 15MM B-V233P-A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1071.2,"discounted_cash":267.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHINCTEROTOME ENDO DASH .025IN X 6FR BILIARY PANCREATIC DISP G25224","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1771.6,"discounted_cash":442.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OSTEOTOME STRAIGHT MEDIAL SZ21 14221","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE INFLATION PRESTO BARREL LARGE 30CC ID4030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT KYPHON KURVE CURVE BONE FILLER DEVICE VPK1003","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10158.78,"discounted_cash":2539.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":10158.78,"discounted_cash":2539.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY SPINAL ANESTHESIA SPROTTE 333740","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":135.65,"discounted_cash":33.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TISSUE SEALER/DIVIDER LIGASURE SMALL JAW LF1212","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2997.09,"discounted_cash":749.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":3028.87,"discounted_cash":757.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2998.23,"discounted_cash":749.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 26FR 5CC LATEX0165L26 BARD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR SURGICAL ALEXIS LARGE 9-14CM C-SECTION G6313","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 0-0 36IN VIOLET CTX GS-25 Y398H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS MONO O 30IN CTX #PDP990G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":43.47,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":43.41,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GUT PL 3-0 CLOSURE 27IN CT #852H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL RAPIDE UND BR 3-0 PLASTIC 36IN CT-1 #VR944","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.15,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS VIL MONO O OB GYN 36IN CT #Z358T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.67,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ON-Q PAINBUSTER PUMP KIT 270ML 2ML/HR P270X2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR O 36IN CTX #J978H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.80,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13.8,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ON-Q CATHETER SILVEROAKER 2.5IN T-PEEL NEEDLE 3.25IN PM010-A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":366.68,"discounted_cash":91.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 0 36 IN VIOLET CT-1 Y346","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.00,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY COUNCILL RED LATEX 2-WAY 20FR 0196L20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":104.85,"discounted_cash":26.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 1 36IN CT-1 #VCP947H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.14,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 2-0 36IN CT-1 #J945H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX 3-0 SPIRAL PDS PLUS 22CM SH-1 SXPP1B453","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":238.78,"discounted_cash":59.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX 2-0 PDS PLUS SPIRAL CT-4 SXPP1B410","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":216.45,"discounted_cash":54.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX PDS PLUS #0 60CM CT-1 SXPP1A440","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":255.83,"discounted_cash":63.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM DELIVERY FETAL PILLOW STERILE LF DISP FP-010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6261.95,"discounted_cash":1565.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT OB VACUUM DELIVERY BELL SHAPED 004CNB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":164.59,"discounted_cash":41.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 4-0 27IN KS D9600","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":375.23,"discounted_cash":93.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 2-0 36IN VIOLET CT-1 Y345H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.41,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 14FR 5CC 2WAY COUDE BARDEX LUBRICATH CARSON","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":71.89,"discounted_cash":17.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 16FR 5CC BARDEX LATEX STERILE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.48,"discounted_cash":4.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 18FR 2-WAY 5CC BARDEX STERILE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ON-Q KIT SILVERSOAKER CATH 5IN T-PEEL NEEDLE 6IN PM020-A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":477.92,"discounted_cash":119.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 4-0 PLASTIC 27IN PS-2 #J426H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":31.62,"discounted_cash":7.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":31.62,"discounted_cash":7.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 3-0 36IN CT-1 #VCP944H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.73,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE POS CLEAR MONO 3-0 G.I.27IN SH #PDP416H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.6,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":20.47,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER CLIP ENDO MULTIPLE TITANIUM 11.5IN 30 MED #MCM30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":418.9,"discounted_cash":104.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP LIGATING LIGACLIP MED LT200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":88.27,"discounted_cash":22.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE CHROMIC GUT CT-1 MONOFILAMENT BROWN 36IN 925H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.05,"discounted_cash":6.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY BATTERY BOVIE HIGH TEMPERATURE FINE TIP 2200F AA01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":58.71,"discounted_cash":14.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROLACT+6 26-CAL/FL OZ HIGH RISK INFANT SUPPLEMENT 93901-30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1776.75,"discounted_cash":444.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROLACT+8 28-CAL/FL OZ HIGH RISK INFANT SUPPLEMENT 93901-40","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2369.0,"discounted_cash":592.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLES ENDO GIA TRISTAPLE 45MM MEDIUM/THICK EGIA45AMT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3326.28,"discounted_cash":831.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDLE EGIA STAPLER LAPAROSCOPIC XL EGIAUXL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 8FR 3CC LATEX 0165S108 BARD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY HYDROGEL SILICONE 22FR 0165SI22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDLE EGIA STAPLER LAPAROSCOPIC EGIAUSTND REPLACED ECH# 030811","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2646.28,"discounted_cash":661.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL 4-0 UNDYED 1X27IN KS J662H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.38,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGASURE IMPACT INSTRUMENT 18CM    LF4200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7408.47,"discounted_cash":1852.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL UND MONO 4-0 PLASTIC 18IN P-3 #Y494G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":41.82,"discounted_cash":10.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC 3-0 CT L36IN  912H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":24.93,"discounted_cash":6.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":24.92,"discounted_cash":6.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 1 36 CTX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.34,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 18FR 30CC LATEX #0166SI18","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":66.02,"discounted_cash":16.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETHRAL RED RUBBER 8FR #CRR-8","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 5-0 BLU MONO 24IN C-1 8725H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":77.15,"discounted_cash":19.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 5-0 18IN BLU RB-1 8756H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.23,"discounted_cash":10.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 5-0 BLU 60CM M1 USP 5/0 DBL ARM RB-2 8554H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.92,"discounted_cash":10.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMCI GUT 2-0 27IN UND MONO SH G123H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.45,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 4-0 27IN UND MONO RB-1 U203H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.9,"discounted_cash":5.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":23.90,"discounted_cash":5.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 3-0 27IN PS-2 #MCP427H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":43.98,"discounted_cash":11.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 5-0 18INUND MONO P-3 687G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":46.25,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 5-0 18IN UND BRD PS-4 #J506G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":31.31,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE TEVDEK NONABSORB 2-0 C-7 L30 IN BRAID GREEN  7-557","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":73.23,"discounted_cash":18.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 1 36IN VIOLET CTX #PDP371T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.38,"discounted_cash":5.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":23.38,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOCLIP MEDIUM TITANIUM 2200W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":133.43,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 4-0 UN 18IN P-3 #MCP494G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 4-0 18IN BLU MONO SA FS-2 8683G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.73,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 0 BLU MONO 30IN CT-1 8424H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.78,"discounted_cash":4.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 2-0 BLK BRD 30IN SH K833H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9.27,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"***SEE 038881*** DRAIN PENROSE 1 X 18 #0918070","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR STRYKER EGG SHAPE 4MM STAINLESS STEEL 1607-002-035","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":249.16,"discounted_cash":62.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 5-0 18 FS-2 #661G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.88,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 4-0 18IN BLK MONO FS-2 662G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 3-0 L18 BRAID 12 STRAND COATED VIOLET #J104T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":66.02,"discounted_cash":16.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 0 12-18IN COATED VIO BRD TIES VCP106G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.94,"discounted_cash":5.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":22.00,"discounted_cash":5.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":22.45,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PLAIN GUT 4-0 18 P-3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 2-0 BLK BRD TIES 12-18IN A185H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11.02,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 0 BLK BRD TIES 6-18IN A186H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 3-0 BLK BRD 12-30IN A304H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.5,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":20.50,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 2-0 BLK BRD TIES 12-30IN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM BORDER 6X6IN #MSC2266EP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":57.79,"discounted_cash":14.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM MEPILEX BORDER AG 4X12IN 498600","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":312.51,"discounted_cash":78.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":313.12,"discounted_cash":78.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING DUODERM 5.5X5.5 IONIC SILVER FLEXIBLE TRANSLUCENT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":32.45,"discounted_cash":8.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE BL MONO 5-0 PLASTIC 18 P-3 12/BX #8698G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":38.52,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE SALEM SUMP 14 FR W/GIENTRI PORT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.51,"discounted_cash":18.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN CHEST OASIS PEDI 200ML 3612-100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":415.3,"discounted_cash":103.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FEMORAL COMPRESSION FEMOSTOP W/HEMOSTATIC DRESSING. MUST ORDER IN QTY/10EA.","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE BREAST BIOPSY BREVERA DISP NEEDLE BREVDISP09","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2198.02,"discounted_cash":549.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING MEPITEL AG 8X12IN 392090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":650.75,"discounted_cash":162.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ARTERIAL KIT 20G 8CM SAC-00820-1A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":459.38,"discounted_cash":114.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IRIS FEEDING TUBE 8 FR x 43 460843E","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2048.46,"discounted_cash":512.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IRIS FEEDING TUBE 10 FR x 43 461043E","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2150.74,"discounted_cash":537.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IRIS FEEDING TUBE 12 FR x 43 461243E","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2048.46,"discounted_cash":512.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSUFFLATION BULB IRIS TUBE 388105E","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":25.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIAD HYDROPHILIC WOUND DRESSING PASTE 2.5OZ  1964","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":56.65,"discounted_cash":14.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH FEMORAL ARTERIAL KIT 18GA 16CM SAC-01618-X1A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1114.46,"discounted_cash":278.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CATH EXTERNAL MALE W/METER MECSM010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":153.99,"discounted_cash":38.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM MEPILEX BORDER AG 4X8IN 498400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":241.02,"discounted_cash":60.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM MEPILEX BORDER AG 4X10IN 498450","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":273.98,"discounted_cash":68.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM MEPILEX BORDER AG 4X14IN 498650","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":362.46,"discounted_cash":90.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":362.46,"discounted_cash":90.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE BREAST BIOPSY SERTERA 12GA 11.5CM SERTERA-12","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":556.61,"discounted_cash":139.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE BREAST BIOPSY 14GA SERTERA-14","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":556.61,"discounted_cash":139.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE LIGASURE MARYLAND OPEN JAW 23CM LF1923","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3914.0,"discounted_cash":978.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":3965.5,"discounted_cash":991.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":3982.67,"discounted_cash":995.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"***SEE 038442*** MEPILEX BORDER FOAM AG 4X12IN 395990","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":274.39,"discounted_cash":68.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALER CURVED LARGE JAW OPEN LF4418","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4438.27,"discounted_cash":1109.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VLOC GS-22 NONABSORABLE  WOUND CLOSURE VLOCN1126","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":270.07,"discounted_cash":67.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PICO SEVEN 2-DRESSING 10CMX30CM 66022003","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2492.6,"discounted_cash":623.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FLOSEAL HEMOSTATIC MATRIX FAST PREP 10ML ADS202110","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2478.9,"discounted_cash":619.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2478.90,"discounted_cash":619.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER SKIN PROXIMATE ROTATING PRW35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":160.18,"discounted_cash":40.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":160.18,"discounted_cash":40.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLICATOR ENDO SURGICEL 3123SPEA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":328.06,"discounted_cash":82.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PICO-7 15X15CM SINGLE DRESSING NEG PRESSURE KIT 66022015","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPONGE SURGIFOAM 8CMX12.5CMX10MM 1974","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":362.66,"discounted_cash":90.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":362.66,"discounted_cash":90.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL UNDYED BRAID 4-0 KS 27IN VCP662H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.61,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PICO-7 NEGATIVE PRESSURE KIT 15x20CM 6x12 66022000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5161.2,"discounted_cash":1290.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR ALEXIS C-SECTION X-LARGE 11-17CM INCISION G6314","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1174.2,"discounted_cash":293.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 0 UNDYED CT-1 36IN MCP946H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GYNECARE TVT TENSION RIGID CATHETER GUIDE REUSABLE 810061","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1432.22,"discounted_cash":358.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PLAIN GUT 2-0 54IN G-204 S103H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36.26,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 3-0 27IN UND MONO CT-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.87,"discounted_cash":5.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":22.86,"discounted_cash":5.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SURGICEL ABSORBABLE HEMOSTAT L8 X W4 IN FLEXIBLE SHEET 1952","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1061.83,"discounted_cash":265.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VAGINAL PACKING 2IN X 5 YARDS STERILE XRAY DETECTABLE 10-031","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":118.35,"discounted_cash":29.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CUP VACUUM EXTRAC MITYVAC M-STYLE MUSHROOM 10007LP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":317.55,"discounted_cash":79.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS II 96IN USP1 LOOP TP-1 PDP880G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":37.9,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":37.90,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":37.56,"discounted_cash":9.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER 45MM TRI-STAPLE CURVED GIA45CTAVM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2252.3,"discounted_cash":563.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING SURGICEL 2IN X 14IN 1951","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":974.35,"discounted_cash":243.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PLAIN GUT 4-0 18 SC-1 STRAIGHT 1828H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.63,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA ANTERIOR CHAMBER 30GA 8065420020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":39.55,"discounted_cash":9.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIPOLAR CUTTING LOOP DIAMETER 0.40MM DISP 27040GP140-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4094.35,"discounted_cash":1023.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FLOSEAL HEMOSTATIC MATRIX FAST PREP 5ML","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1470.94,"discounted_cash":367.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STIMULATOR EXTERNAL TRIAL 1601","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":566.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT NEUROSTIMULATOR TINED LEAD 1801","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3553.5,"discounted_cash":888.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SWANN-MORTON CERVICAL BIOPSY CIG01C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":111.34,"discounted_cash":27.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA OPHTH HYDRO 11MM 27GA 8065441720","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":46.87,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPANDER OPHTHALMIC MALYUGIN 2.0 RING 7.0MM MAL-1002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1416.25,"discounted_cash":354.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 MONO 18IN BLUE 8697G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":39.86,"discounted_cash":9.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR ONETRAC LX 135X30 C100210","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR ONETRAC LX 90X60 C100230","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR ONETRAC LX 90X20 C100240","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR ONETRAC LX 135X60 C100260","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRACKER FUSION AXIEM EM ENT INSTRUMENT DISP 9733533","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1403.27,"discounted_cash":350.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE IPRISM GONIO LENS SX1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"27G CAPSULE CANNULA POLISHER TERRY SQUEEGEE 8065-428-220","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":50.26,"discounted_cash":12.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYMPHION RESECTING DEVICE 3.6 FG-0201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9000.99,"discounted_cash":2250.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYMPHION FLUID MANAGEMENT ACCESSORIES FG-0202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR LAP KII FIOS FIRST ENTRY 5X100MM CFF03","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":597.4,"discounted_cash":149.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOUND DEBRIDEMENT IRRISEPT ISEPT45USA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":669.5,"discounted_cash":167.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE LOOP BIPOLAR OD.30MM 24/26FR 27040GP130-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3559.68,"discounted_cash":889.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE TISSUE REMOVAL (10-401FC EACH) REACH MYOSURE 10-403FC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8719.25,"discounted_cash":2179.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE BIPOLAR 24-27F BUTTON 27040NB-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3559.78,"discounted_cash":889.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALANT FIBRIN TISSEEL PRIMA FROZEN 4ML 1501262","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1672.1,"discounted_cash":418.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE REINFORCED ENT 3.5IN STERILE DISP RAN-027-5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":334.65,"discounted_cash":83.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE INFERIOR TURBINATE 11CM X 2MM DISP 1882040HR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2442.65,"discounted_cash":610.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE REMOVAL TRUCLEAR TISSUE INCISOR DISP 72202536","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHAVER TRUCLEAR DENSE TISSUE MINI DISP 72204064","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7627.87,"discounted_cash":1906.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SURGICAL BEAVER BLADE MINIATURE 64 STERILE 01SM64","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18.71,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTERFACE PATIENT LENSX SOFTFIT STANDARD DISP 8065998225","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE DOPPLER VTI 20MHZ DISP 108200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1959.58,"discounted_cash":489.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE MONO REVERSE 2-0 18IN FS BLUE 8685H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.81,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":20.80,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WAND ENDO PLASMA PROCISE MAX ELECTRODE EICA8898-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3238.73,"discounted_cash":809.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OMNI SURGICAL SYSTEM DISP 1-102","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13505.99,"discounted_cash":3376.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH SAVI SCOUT SURGICAL GUIDE SH-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ROUND LOOP 10X10mm 11cm YELLOW SHAFT #DLP-S11","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR WOUND ALEXIS SMALL 2.6-6CM INCISIONS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":669.5,"discounted_cash":167.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR O CLOSURE 27IN CT-2 #J270H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 3-0 G.I.27IN SH #J416H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 2-0 UD 27IN SH #VCP417H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 4-0 18IN PS-2 #VCP496ZG","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":33.48,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL O SUTUPAK 6x18\" #VCP112G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":48.58,"discounted_cash":12.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":42.02,"discounted_cash":10.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":42.45,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 2-0 CUTICUL.18IN FS 36/BX #664H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER CLIP ENDO MULTIPLE TITANIUM 9 3/8IN 20 SML #MCS20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":365.65,"discounted_cash":91.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE POS CLEAR MONO 5-0 PLASTIC 18IN P-3 #Z493G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":40.06,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR SURGICAL ENDOPATH DILATING TIP 11MMX100MML #D11LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.13,"discounted_cash":44.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR SURGICAL ENDOPATH DILATING TIP 12MM 100MML #D12LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.13,"discounted_cash":44.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE BL MONO O CLOS URE 3O II CT -2 #8412H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE BL MONO 2-0 CLOSURE 30IN CT-2 #8411H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DISSECTOR ENDOSCOPIC BLUNT TIP ENDOPEANUT 5MM 40CM BTD05","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":94.87,"discounted_cash":23.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP LIGATING LIGACLIP SMALL LT100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 3-0 CUTICULAR 18IN FS-1 #SN663G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":21.95,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":22.08,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE MICRO MEDIUM-MEDIUM 2296-033-105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.36,"discounted_cash":54.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER BURR OVAL MEDIUM 4.0MM 5300-010-901","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":132.56,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE BALL 5MM DIAMETER 11CM SHAFT (RED)","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":165.83,"discounted_cash":41.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR WOUND ALEXIS MEDIUM 5-9CM INCISION","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":669.5,"discounted_cash":167.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE XPS STRAIGHTSHOT INFERIOR TURBINATE 2.9MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2442.65,"discounted_cash":610.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE XPS STRAIGHTSHOT ETHMOID TRICUT 4MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2134.12,"discounted_cash":533.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 3-0 36INCH BLUE SH  #8522H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":41.82,"discounted_cash":10.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER TOURNIQUET CUFF DISP. 18 INCH RED  5921-218-235","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":122.06,"discounted_cash":30.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":122.06,"discounted_cash":30.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER TOURNIQUET CUFF DISP 24 INCH YELLOW  5921-024-235","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":465.97,"discounted_cash":116.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER TOURNIQUET CUFF DISP 34 INCH PURPLE  5921-034-235","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":513.83,"discounted_cash":128.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"UTAH ELECTRODE LETZ LOOP 20MMX12MM  DLP-W11","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":165.83,"discounted_cash":41.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY BLADE EXTENDER 4INCH TEFLON COATED  E1450-4","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":35.95,"discounted_cash":8.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET IRRIGATION FLUID WARMING RANGER #24750","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":386.04,"discounted_cash":96.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 22FR 30CC 3WAY LATEX BARDEX LUBRICATH #0167L22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.1,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"UROVAC BLADDER EVACUATOR M0067301251","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":187.77,"discounted_cash":46.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STORZ TUBING Y-SET FOR SUCTION 030247-10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":197.25,"discounted_cash":49.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRO-LUBE ANTI-STICK SOLUTION EL 101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":377.1,"discounted_cash":94.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MANIPULATOR UTERINE CONMED V-CARE LARGE 60-6085-202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":509.03,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SOLUTION IRRIGATION STERILE 0.9% NACL 500ML BOTTLE 2F7123","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER BURR OVAL MEDIUM 5.5MM 5300-10-903","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":132.56,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ROUND LOOP 15X12MM 11CM GREEN SHAFT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PENCIL ELECTROSURG CAUTERY 8FTL PTFE-COATED HAND 0035H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":50.06,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COAGULATOR ELECTROSURG SUCTION 10FR DIA 6INL 004025","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.51,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 2-0 27IN VIOLET CT-2 #PDP333H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.32,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":20.96,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PERMA-HAND SILK 6-0 G-1 L18 IN 2 ARM BRAID BLACK 780G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":74.26,"discounted_cash":18.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 0 8-18IN CT-1 #VCP740D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":24.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTR POLYDEK 1 18 KHT-3 69-5040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":14.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 2-0 BLU MONO 30IN SH 8833H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.63,"discounted_cash":5.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE FAST ABSORBING PLAIN GUT 5-0 18IN PC-1 1915G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":49.96,"discounted_cash":12.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC BLADE RAD40 FUSION 1884006EM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3283.13,"discounted_cash":820.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPANDER OPHTHALMIC MALYUGIN RING 6.25MM MAL-0001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1502.05,"discounted_cash":375.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"XOMED BLADE TRICUT 3.5MM 1883504HR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1933.1,"discounted_cash":483.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ENDO-SCRUB SINUS LENS 4MM 0 DEGREE 1912000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":649.42,"discounted_cash":162.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":649.42,"discounted_cash":162.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ENDO-SCRUB SINUS LENS 4MM 30 DEGREE 1912010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":589.06,"discounted_cash":147.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER TRICUT M4 STRAIGHT ROTATE 4MM 1884004HR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1809.3,"discounted_cash":452.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 4-0 18IN BLU BRD RB-1 8757H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.33,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN BLAKE 15 FR ROUND FULLY FLUTED W/O TROCAR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.69,"discounted_cash":33.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":133.21,"discounted_cash":33.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GYRUS EAR VENT TUBE COLLAR BUTTON 1.27MM 14-5214","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":419.21,"discounted_cash":104.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 4-0 PS-2 UNDYED 27IN Y426H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":39.76,"discounted_cash":9.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 0 UD 27IN CT-1 #VCP260H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.54,"discounted_cash":6.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":25.54,"discounted_cash":6.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"UROPLASTY ENDOSCOPIC NEEDLE MRN-420","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":422.3,"discounted_cash":105.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY SUCTION FOOT CONTROL #E2505-10FR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":60.46,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 4-0 27IN RB-1 #VCP304H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.32,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPONGE GELFOAM ABSORBABLE GELATIN 12-7MM 09-0315-08","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.95,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR BLADED STANDARD SMOOTH 5MM B5STS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":567.84,"discounted_cash":141.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DIVIDER BLUNT TIP LAP SEALER  LF1837","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4083.85,"discounted_cash":1020.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":4082.15,"discounted_cash":1020.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR SHARP HOOK LONE STAR DISP 3311-8G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":597.4,"discounted_cash":149.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR STAY LONE STAR 12MM 3350-8G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":597.4,"discounted_cash":149.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE DERMATONE PADGETT STERILE DISP 3539-252","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":832.24,"discounted_cash":208.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STIMULATOR/LOCATOR VARI-STIM III HAND-HELD #8562010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":601.09,"discounted_cash":150.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC INSTRUMENT TRACKER 9733533XOM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1632.55,"discounted_cash":408.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ELECTROSURG CAUTERY STANDARD 6.5INL 0014M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":47.38,"discounted_cash":11.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE POLYSORB 3-0 30IN VIOLET V-20 GLS-122","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":37.49,"discounted_cash":9.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VLOC 180 0 GR 9 GS-21 VLOCL0346","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE TRUCLEAR ULTRA PLUS 72203012","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6379.98,"discounted_cash":1595.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE QUADCUT 4.3MM X 13CM STRAIGHTSHOT 1884380EM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3570.29,"discounted_cash":892.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM CROSSBOW FASCIAL CLOSURE SE-CB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":990.86,"discounted_cash":247.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":990.24,"discounted_cash":247.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX 3-0 PS-2 MONOCRYL 60CM UNDYED SXMP1B108","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":206.76,"discounted_cash":51.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KWIRE GEMINUS STANDARD TIP 1.5X127 KWIR-STD-15127","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":247.2,"discounted_cash":61.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT GEMINUS SOLID SIDE CUT 2.0X40 DRLL-SSC-20040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1040.3,"discounted_cash":260.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE MYRINGOTMY 45 DEGREE OFFSET 7120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":12.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT GEMINUS SOLID SIDE CUT 2.5X40 DRLL-SSC-25040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1040.3,"discounted_cash":260.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN 15FR ROUND HUBLESS JP-2228","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":139.26,"discounted_cash":34.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE MINI SURGICAL TIP ROUND BEAVER6400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.66,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":19.78,"discounted_cash":4.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE LIGASURE LAP MARYLAND JAW LF1937","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":4068.5,"discounted_cash":1017.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRIVER GEMINUS SQUARE TIP AO CONNECTION DRVR-AOS-S20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":576.8,"discounted_cash":144.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALER DIVIDER LIGASURE 23CM BLUNT LF1823","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4511.19,"discounted_cash":1127.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PENCIL ELECTROSURGICAL CAUTERY 10FTL STAINLESS MMP0039H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":30.59,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ELECROSURGE CAUT 2.75INL 0013M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":37.39,"discounted_cash":9.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLE ENDO TRI-STAPLE TAN VASC MED STRAIGHT 30MM SIG30AVM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2858.56,"discounted_cash":714.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE ENDOTRACHEAL TRIVANTAGE NIM 6MM 8229706","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3632.19,"discounted_cash":908.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER PREMIUM SURGICLIP III S-9.0 133650","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1251.45,"discounted_cash":312.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM PREVENA NEGATIVE PRESSURE VAC THERAPY UNIT CONNECTOR 13CM PRE1101US.S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4354.53,"discounted_cash":1088.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORD BIPOLAR DUAL 12FT DISPOSABLE US349SP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":75.91,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE ENDOTRACHEAL NIM EMG 7MM 8229707","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3632.19,"discounted_cash":908.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC ABBOTT CARTRIDGE PLATINUM SERIES FOR HANDPIECE 1MTEC30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC ABBOTT CARTRIDGE EMERALD SERIES FOR HANDPIECE EMERALDC30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER LIGACLIP MEDIUM 30 DEGREE 11.5IN VASC MCM20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":365.51,"discounted_cash":91.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR XCEL ENDOPATH 10CM DILATING TIP STABILITY SLEEVE D5LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.13,"discounted_cash":44.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE VERRES 120MM OUTER CANNULA DISP UV120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":129.78,"discounted_cash":32.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR EXCEL OPTIVIEW UNIVERSAL SLEEVE 5MM 2CB5LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":129.78,"discounted_cash":32.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX GRADUATED DRILL BIT 2.5MM AR-8943-42","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEARS HARMONIC FOCUS PLUS 9MM HAR9F","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3596.52,"discounted_cash":899.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KNIFE OPHTH CLEARCUT SLIT 2.4MM DISP 8065992445","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":267.49,"discounted_cash":66.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DEVICE BB TACK THREADED AR-13226T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACKING NASAL XEROGEL EPISTAXIS 0.3 X 4 X 2.4CM XG-102","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1322.93,"discounted_cash":330.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLICATOR FLOSEAL MALLEABLE TIP 41CM  0600225","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":590.09,"discounted_cash":147.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 2-0 27IN VIOLET SH #MCP317H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.62,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.66,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP APPLIER PREMIUM SURGICLIP II M-11.5 MEDIUM #134053","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1428.1,"discounted_cash":357.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 3-0 36IN VIOLET SH Y527H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":27.6,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":27.59,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SENSOR ARRAY PILLCAM DR3 8 LEAD FGS-0427","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT EMR CAPTIVATOR M00561600","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3347.5,"discounted_cash":836.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VERSAFLEX CATH PH MONITOR 6FR DISP 900003","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1317.37,"discounted_cash":329.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VERSAFLEX CATH PH MONITOR PEDI 15CM FGS-9000-17","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1205.1,"discounted_cash":301.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BASKET RETRIEVEL HOOK SPECIMEN 190CMX20MM FG-V431P","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2193.9,"discounted_cash":548.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE ENDO ACQUIRE FNB 22GA M005555540","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4068.5,"discounted_cash":1017.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAPSULE PILLCAM SB 3-EX FGS-0499","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ATTACHMENT DISTAL DISPOSABLE STERILE D-201-15004","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":248.23,"discounted_cash":62.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ENDO POLYPECTOMY CAPTIVATOR XL RND STIFF M00561290","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE AUTOLITH TOUCH 1.9FR 375CM M00546620","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4418.7,"discounted_cash":1104.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS COAGRASPER HEMOSTATIC (COLON) DISP FD-411UR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2389.6,"discounted_cash":597.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VIZISHOT 2 FLEX 19G NA-U403SX-4019","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2739.8,"discounted_cash":684.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OVERTUBE FOR DOUBLE BALLOON SCOPE STR DISP TS-13140","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2338.1,"discounted_cash":584.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BIOPSY ACQUIRE FNA 19G FLEX M00555580","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT PILLCAM SENSOR BELT COVER DISPOSABLE FGS-0510","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":63.86,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANOSCOPE EXAMINATION SLOTTED 90 X 18M DISP C060100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":47.9,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADVANIX PANCREATIC NAVIFLEX RX 10FR M00535080","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":813.7,"discounted_cash":203.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OLYMPUS SNARE DISTAL ATTACHMENT 13.4MM D-201-12704","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":248.23,"discounted_cash":62.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OLYMPUS SNARE 2.8MM X 2300MM SD-210U-10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":87.04,"discounted_cash":21.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OLYMPUS NEEDLE VIZISHOT 21GA EBUS ASPIRATION NA-201SX-4021","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1163.9,"discounted_cash":290.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY BIOPSY W/0 NEEDLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":100.53,"discounted_cash":25.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE POLYPECTOMY ACUSNARE 1.5 X 2.5CM ASMH-1-S G22701","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":25.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY COUDE CARSON 14FR 5CC LATEX #0168SI14","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":119.58,"discounted_cash":29.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ENDO DUCK BILL 7FR 25MM DISP WHITE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":231.75,"discounted_cash":57.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTOR PRO RX RETRIEVAL BALLOON 15-18","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1462.6,"discounted_cash":365.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTOR PRO RX RETRIEVAL BALLOON 12-15","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1462.6,"discounted_cash":365.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTOR PRO RX RETRIEVAL BALLOON 9-12 #4700","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1462.6,"discounted_cash":365.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS ELECTROSURGICAL COAGRASPER 2.8MM FD-410LR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1895.2,"discounted_cash":473.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OTSC SYSTEM SET 11/6A 165CM BLUNT TEETH 100.09","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1048.54,"discounted_cash":262.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPECT SLIMLINE 19GA FLEX NEEDLE 5553","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4377.5,"discounted_cash":1094.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPECT SLIMLINE 22GA ASPIRATION NEEDLE 5551","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPECT SLIMLINE 25GA ASPIRATON NEEDLE 5552","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADVANIX PANCREATIC NAVIFLEX RX 7FR M00535060","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":813.7,"discounted_cash":203.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OVERSTITCH ENDO SUTURE SYSTEM ESS-G02-160","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11487.75,"discounted_cash":2871.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE OVERSTICH 2-0 PLOYPROPYLENE M00505451","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":805.98,"discounted_cash":201.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE OVERSTICH SUTURE CINCH 6 UNIT M00505530","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1043.7,"discounted_cash":260.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OVERSTICH TISSUE HELIX THX-165-028","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2533.8,"discounted_cash":633.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIAPC CIRCUMFERENTIAL PROBE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ELECTROSURGICAL SPIRAL DISPOSABLE SD-230U-20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":213.21,"discounted_cash":53.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GASTRIC LENGTH OVERTUBE  (8.6-10.0)","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2214.5,"discounted_cash":553.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COOK DUETE MULTI BAND MUCOSECTOMY 9.5-13MM 5FR 2.8MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2987.0,"discounted_cash":746.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SOEHENDRA BILIARY DIL CATHETER (6)","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":751.9,"discounted_cash":187.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUARDUS OVERTUBES ESOPHAGEAL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1915.8,"discounted_cash":478.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MINI HEXAGONAL SNARE   ASMH-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":109.9,"discounted_cash":27.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BRUSH CYTOLOGY RAPID EXCHANGE #M00545000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1060.9,"discounted_cash":265.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KNIFE RAPID EXCHANGE NEEDLE RX #M00545840","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1905.5,"discounted_cash":476.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADVANCE CAPSULE ENDOSCOPE DELIVERY DEVICE #00711144","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1733.8,"discounted_cash":433.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS BIOPSY STD OVAL CUP DISPOSABLE FB-231D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":234.84,"discounted_cash":58.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"22 GA. EUS ASPIRATION NEEDLE - 1 PACK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2111.5,"discounted_cash":527.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAPTIFLEX OVAL FLEXIBLE SINGLE USE MEDIUM M00562401","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":142.14,"discounted_cash":35.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DBL LUMEN BILIARY CYTOLOGY BRUSH","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1081.5,"discounted_cash":270.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TACK FIXATION CLAW II PLATE DISPOSABLE 40250010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":988.8,"discounted_cash":247.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SOEHENDRA BILIARY DILATION 7FR 200CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":751.9,"discounted_cash":187.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEPLOYMANT CATHETER FOR EMPHYSEMA VALVE SVS-C26N-06","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8559.5,"discounted_cash":2139.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZING KIT FOR SPIRATION EMPHYSEMA VALVE SVS-VSK-KIT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOUGIE CAP 7 5.5-6mm 7.1mm/18FR  400.31.01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":642.03,"discounted_cash":160.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE ACQUIRE PULMONARY 25GA FINE NEEDLE BIOPSY M00552400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3656.5,"discounted_cash":914.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ION ENDOLUMINAL 21G BIOPSY NEEDLE 490103-09","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPYSCOPE DS II CATH ACCESS & DELIVERY M00546610","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20506.5,"discounted_cash":5126.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCISSORS ENSIZOR ENDOSCOPIC 235cm ES26235","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP LIGATION RESOLUTION 360 ULTRA 17MMX235CM DISP M00521401","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2461.7,"discounted_cash":615.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE DEFENDO AIR WATER CONNECTOR 100322","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":95.28,"discounted_cash":23.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BASKET SPECIMEN RETRIEVAL DISP FG-V451P","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3230.08,"discounted_cash":807.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SOEHENDRA BILIARY DILATION 8.5FR 200CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":751.9,"discounted_cash":187.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VAC CANISTER 1000ML  M8275093/5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":384.6,"discounted_cash":96.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOUND VAC CANISTER KIT 500CC M8275063/10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":304.16,"discounted_cash":76.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT DRAINAGE PLEURX 1000ML STARTER  50-0071","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2497.75,"discounted_cash":624.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOUND VAC Y CONNECTOR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.66,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIC PAD WOUND DRAIN TRAC PAD Tubing CLAMP CONNCTR M8275057/10.S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":156.15,"discounted_cash":39.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POUCH UROSTOMY ULTRAMAX DEEP 1-1/2 72638","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":149.35,"discounted_cash":37.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING GEL AG 1.5OZ TUBE #MSC9301EP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":160.27,"discounted_cash":40.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING DRIGO-HP 10\" X 12' #MSCWH219","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":478.95,"discounted_cash":119.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"***SEE 038487 *** WOUND SILVER HYDROGEL 1.5oz","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":19.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER PULMONARY ARTERY SWAN-GANZ COMBO 8FR 110CM 777F8","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2486.21,"discounted_cash":621.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BRUSH CYTOLOGY BC-1SC DISPOSABLE STERILE #BC-202D-2010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":135.96,"discounted_cash":33.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POWERLOC MAX ALLPOINTS NEEDLE SET 20GA 0.75IN AN132075","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POWERLOC MAX BIOPATCH ALLPOINTS NEEDLE SET 20GA 1IN AN142010B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH URETHRAL HEMATURIA COUDE 24FR 30CC 3 WAY #2557H24","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":146.98,"discounted_cash":36.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING PREVENA 20CM PRE1055US.S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2557.59,"discounted_cash":639.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANISTER PREVENA 45ML PRE1095.S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":256.16,"discounted_cash":64.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT DRILL BIT 2.8MM 40250028","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1668.6,"discounted_cash":417.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING AQUACEL AG SURGICAL COVER 3.5 X 4IN 412009","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":183.34,"discounted_cash":45.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLAW II DRILL BIT 2.0MM 40250020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1163.9,"discounted_cash":290.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLOSURE TR HEMOBAND 18MLX24CM-TERUMO","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":298.7,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":299.38,"discounted_cash":74.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 30FR 30CC LATEX #0166SI30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":66.02,"discounted_cash":16.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VAC VERAFLO CLEANSE CHOICE DRESSING MEDIUM ULTVCC05MD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1303.78,"discounted_cash":325.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RADIAL JAW 4 PULMONARY W/NDL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND EXCEL O 30\" GRN CT-2 D8224","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":448.57,"discounted_cash":112.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 2-0 30IN BLU MONO SA CT-1 8423H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.09,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 4-0 BLU MONO SH 36IN 8521H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.33,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 5-0 BLU MONO 36IN RB-1 8556H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":43.05,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 4-18IN BLUE D/A C-1 M8718","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":310.85,"discounted_cash":77.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 4-0 BLU MONO 36IN RB-1 8557H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 4-0 12-18IN BLK BRD TIES #A183H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.32,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PLAIN GUT 3-0 30 V-20 G322H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GUT PLAIN 4-0 27IN FS-2 H821H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 7-0 4-18IN BLU CV-1 M8701","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":394.70,"discounted_cash":98.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":394.7,"discounted_cash":98.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 2-0 12-18IN COATED VIO BRD TIES J105T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":66.54,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 3-0 8-30IN BLK BRD CR C017D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":66.74,"discounted_cash":16.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":66.74,"discounted_cash":16.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 5-0 30 C-13 #SG634G ** DO NOT USE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.72,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS II 3-0 18IN VIO MONO CR Z774D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":140.39,"discounted_cash":35.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 4-0 VIOLET 27IN SH-1 #PDP310H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.69,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HYDRAJAW SET 33MM HYDRA33","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HYDRAJAW SET 61MM HYDRA61","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP CARDIAC FOGARTY SOFT JAW 6MM 10/CASE CSOFT6","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.26,"discounted_cash":24.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOCLIP SMALL 6PACK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.22,"discounted_cash":5.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOCLIP LARGE ORANGE LIGATING TITANIUM STERILE 6CLIP/PK #4200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":48.89,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":48.93,"discounted_cash":12.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET GUIDE PIN 3.2 X 444MM THREADED 2810-01-175","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1218.39,"discounted_cash":304.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC BAYONET KNIFE LONG 188MM 1563-00","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3756.41,"discounted_cash":939.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE PROCEDURE 18GA X 2-3/4","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.88,"discounted_cash":4.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS II 2-0 8-18IN VIO MONO CR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":139.36,"discounted_cash":34.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 2 BLK MONO 30\" DA LR 490T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.79,"discounted_cash":5.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 0 48 CTX PDP370T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.42,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 2-0 EXCEL GRN BRD TIES 12-18IN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 0 6-18IN TIES A186H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 0 EXCEL GRN BRD 30IN CT-1 X424H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 2-0 8-18IN COATED VIO BRD MO-4 J700D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":116.08,"discounted_cash":29.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 2-0 3-18IN COATED VIO BRD OS-8 J716T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":53.97,"discounted_cash":13.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 4-0 27IN COATED VIO BRD SH-1 VCP310H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.32,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 3-0 27IN COATED UND BRD FS-1 J442H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.82,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 0 EXCEL GRN BRD 8-18IN CTX CR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":79.83,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE WAX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":37.8,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE POLYESTER TAPE1/8 X 2 X 36 #8618-00","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":43.26,"discounted_cash":10.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NUROLON 4-0 8-18IN BLK BRD CR C584D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":103.52,"discounted_cash":25.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 0 27IN CT-1 # PDP340H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":37.8,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL ANTIBACTERIAL  2-0 8-18IN CT-2 #J726D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":87.81,"discounted_cash":21.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":87.82,"discounted_cash":21.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY NEEDLE W/VALVED COAXIAL INTRODUCER 16GA 15CM TEVC1615","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":842.03,"discounted_cash":210.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXCAVATOR SURGICAL OTSG XCAVATOR 165CM 200.15","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3084.85,"discounted_cash":771.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE BIOPSY ACQUIRE S FRANSEEN ULTRASOUND FINE NEEDLE TAPER POINT 22GA M00555640","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4068.5,"discounted_cash":1017.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SCLEROTHERAPY CARR-LOCKE TEFLON 25GA 230CM 2.5X5MM 00711811","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":78.28,"discounted_cash":19.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ENDOSCOPIC HABER RAMP 8-6FR 200CM G25194","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":968.2,"discounted_cash":242.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP ENDO MANTIS TRUGRIP 2.8X235CM M00521420","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4171.5,"discounted_cash":1042.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDOSCOPIC INSTRUMENT OTSC NITINOL ADULT SET 7MM 165CM 100.50","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6297.99,"discounted_cash":1574.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AUTOCAP RX DEVICE LOCK M00545101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":164.70,"discounted_cash":41.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ENDOSCOPIC ACUSNARE TEFLON NITINOL DUCKBILL 7FR 25MM 240CM G22649","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":231.75,"discounted_cash":57.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAPSULE PH BRAVO CALIBRATION FGS-0636","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDOSCOPIC INSTRUMENT REMOVE DC BIPOLAR CUTTER SET 220CM 9.5-12MM 400.02.01S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5036.7,"discounted_cash":1259.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGATOR ENDOSCOPIC SPEEDBAND SUPERVIEW SUPER 7 SQUARE M0054225","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE NEEDLE ULTRA-PRO 91.5CMX14CM 610-608","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.03,"discounted_cash":44.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHINCTEROTOME ENDOSCOPIC CLEVERCUT3V PRELOAD DISTAL TIP 20MM KD-VC611Q-07201S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3852.2,"discounted_cash":963.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MARKER ENDOSCOPIC BLUE BEACON 0.4% INDIGO 5ML IC62021","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CELLEBRITY CYTOL BRSH 1.9/150","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":104.24,"discounted_cash":26.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE KNIFE HUIBREGTSE SINGLE LUMEN 5FR G22037","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1926.1,"discounted_cash":481.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY FORCEP JUMBO DBF-2.8SJN-230SP-40-S G56999","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":175.1,"discounted_cash":43.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SCHLEROTHERAPY INTERJECT #M00518360","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":298.7,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT GUIDE NEEDLE 8.5FR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":173.86,"discounted_cash":43.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BASKET BILIARY 1.5CM X 3.5CM  G22775","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOOP LIGATION POLYLOOP DETACHABLE HX-400U-30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":679.8,"discounted_cash":169.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGATOR SPEEDBAND SUPERVIEW 2/BOX #4225","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1416.25,"discounted_cash":354.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDLE ALLIANCE INFLATION","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2984.94,"discounted_cash":746.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGATOR MULTI-BAND 6-SHOOTER MBL-6-OV","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2214.5,"discounted_cash":553.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARES JUMBO 33MM*DO NOT USE SEE 027858","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":158.41,"discounted_cash":39.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE (ORDER X10) FIAPC FIRE STRAIGHT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2322.65,"discounted_cash":580.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE (ORDER X10) FIAPC FIRE STRAIGHT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2322.65,"discounted_cash":580.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ENDOSCOPIC SOFT ACUSNARE TEFLON NITINOL STANDARD OVAL 7FR 2.5X5.5X240CM G22632","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHINCTEROTOME CLEVERCUT 3V STRAIGHT PRELOAD 20MM KD-VC631Q-07201S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3852.2,"discounted_cash":963.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGATOR SPEEDBAND SUPERVIEW SUPER 7 M00542253","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BILE BAG SMALL 9OZ","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":75.4,"discounted_cash":18.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 20FR 5CC LATEX 0165SI20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 20FR 30CC LATEX #0166SI20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":66.02,"discounted_cash":16.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 22FR 30CC LATEX #0166SI22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":66.02,"discounted_cash":16.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":66.02,"discounted_cash":16.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA CRYSTAL PARTIAL THREAD 5.75X7CM AR-6564","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 7-0 CC 24IN BLUE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":119.79,"discounted_cash":29.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"***SEE 038486*** DRESSING SILICONE FOAM 4X8IN FM48","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":49.34,"discounted_cash":12.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DRILL BIT GRADUATED 2MM AR-8943-16","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETHRAL RED RUBBER 12FR 277712","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE DAVIS TONSIL TAPER POINT 1849DC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":24.1,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHINCTEROTOME JAGTOME REVOLUTION PRO RX 39 CANNULATED M00584470","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4017.0,"discounted_cash":1004.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP HEMOSTASIS LOCKADO 235CM 2.6X16MM LO30895","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1081.5,"discounted_cash":270.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDOSCOPIC DEFENDO BIOSHIELD AIR WATER BIOPSY VALVE BX00711901","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":489.25,"discounted_cash":122.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE SUTURING LONG CINCH M00505550","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1879.75,"discounted_cash":469.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT ENDOSCOPIC COMPLIANCE ORCAPOD 4 1.1OZ 6FT CEK-1800-20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":180.66,"discounted_cash":45.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE NASOJEJUNAL FEED SMALL BOWEL 10FR 50X260CM G22301","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON PULMONARY DILATION CRE 60CC 15ATM M00550630","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":391.4,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT INTRACORONARY CLEARVIEW 1.25MM 31125","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":646.84,"discounted_cash":161.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE AID BOOTIES JAW COVERS  300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":793.1,"discounted_cash":198.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":791.04,"discounted_cash":197.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BATTERY PACK SYNTHES STERILE DISPOSABLE 05.000.007.01S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2250.76,"discounted_cash":562.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLES ENDO GIA TRISTAPLE 60MM MEDIUM/THICK EGIA60AMT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3516.63,"discounted_cash":879.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ET DRAGONFLY 2-CHANNEL 7-8.5MM OD LSE500DCS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLAST088 LONG SEATH 90CM BALLAST90","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SUPPORT CXI-2.6-18-150-ANG G56553","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":437.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"M5IVL CATHETER 7x60mm M5PIVL7060","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28876.5,"discounted_cash":7219.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS SPYBITE MAX BIOPSY 286CM  DISP M00546470","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5098.5,"discounted_cash":1274.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLAST088 LONG SEATH 80CM BALLAST80","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BASKET SPYGLASS SPECIMEN RETRIEVAL 15X286 DISP M00546550","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5098.5,"discounted_cash":1274.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRIEVER TREVO NXT 3X32 TRAK21 2-PK 91312","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":56860.19,"discounted_cash":14215.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ATRIEVE VASC SNRE KIT DIAM 12-20MM 6FR 382006020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ATRIEVE VASC SNRE KIT DIAM 18-30MM 7FR 382007030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT REMOTE FREELINK SC-5572-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11713.0,"discounted_cash":2928.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANGIOTOUCH STANDARD HAND CONTROL KIT AT-X65 65CM 016795","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DELIVERY CATH SYS INLINE SHEATH 14FR 23-29MM D-EVOLUTFX-2329","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14055.6,"discounted_cash":3513.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SPYGLASS DISCOVER T/A DIGITAL DISP M00546780","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23017.5,"discounted_cash":5754.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC DEVICE INFLATION ATRION QL2530 LOCK SYRINGE 96402","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC TRIEVER24 ASPIRATION GUIDE CATHETER 24FR 95CM 22-101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STATSEAL ADVANCED PLUS DISC DAP019","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":198.28,"discounted_cash":49.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLEEVE CONTAMINATION CON-006-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":114.33,"discounted_cash":28.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LONG TUNNELING TOOL NEUROSTIM 28CM SC-4252","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH NEURO SELECT BER 6F X 125CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHECK-FLO HEMOSTASIS ASSEMBLY G06002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LEAD ACC KIT 17CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BRIDGE PREP KIT 591-001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":798.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC CATHETER PACING RIGHT SITE FIXED 43CM C315HIS02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MARKSMAN 160CM FA-55160-1030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11406.66,"discounted_cash":2851.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER MPA2 4FX125CM 538-444","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":103.93,"discounted_cash":25.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR 6FR 20CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACEMAKER PACK SAN51PPECE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1106.12,"discounted_cash":276.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM ELECTRODE DELIVERY TOOL 4712","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9010.0,"discounted_cash":2252.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ION ENDOLUMINAL 19G BIOPSY NEEDLE 490104","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENROUTE NEUROPROTECTION SYSTEM SR-250-NPS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28022.76,"discounted_cash":7005.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON TRUE DILATATION 18MM 4.5X110CM 0184511","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEUROSTIMULATOR WAVERWRITER TRAIL KIT SC-6500-72","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE LIVEWIRE RESPONSE ENSITEX 20 PIN D-ENS-L/R-DDY-CBL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2571.07,"discounted_cash":642.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRENCH KIT MEDTRONIC 5873W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":370.8,"discounted_cash":92.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE PACING MEDTRONIC 5833SL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STYLET KIT MOND RVOT MED CURVE 58CM 4141/58","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":834.3,"discounted_cash":208.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STYLE KIT MEDTRONIC 0.014IN TAPERED BALL TIP 52CM 6082-52","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCESSORIES HI PRESSURE CONNECTING TUBING 122CM-MERIT MEDICA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":31.11,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCESSORY ACCUSON STERILE SWIFTLINK US TRANSDUCERCOVER-CIVCO","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":97.81,"discounted_cash":24.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON VENOGRAM ATTAIN MEDTRONIC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLOSURE TR HEMOBAND 18MLX29CM-TERUMO","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":300.54,"discounted_cash":75.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER KMP 5F 40CM G47044","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOSTON LONG TUNNELING TOOL NEUROSTIM SC-4254","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE CATHETER SUPREME ENSITEX 4 PIN D-ENS-SUP-Q-CBL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1924.42,"discounted_cash":481.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE SURFACE KIT ENSITE X ENSITE-SEK-5-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":48675.0,"discounted_cash":12168.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIO-MEDICUS NEXTGEN CANNULA PERFUSION 25FR 96600-125","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4156.26,"discounted_cash":1039.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE HEMOSTASIS WATCHDOG KIT H74939343A021","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":359.47,"discounted_cash":89.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGNOSTIC FEMORAL 3DRC (WILLIAMS) 100CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 5-0 24IN BLU BRD DA BV-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":159.65,"discounted_cash":39.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR STANDARD 7FR 20CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR STANDARD 5FR 20CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR STANDARD 9FR 20CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":99.91,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACT-O-TAPE SURG 12 18 G  1041","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":200.23,"discounted_cash":50.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA ARTERIAL FEMORAL 18FR FEM-FLEX II  FEMII018AS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2397.12,"discounted_cash":599.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 24 INCH BLUE C-1 CV-11  ETM8726","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":310.85,"discounted_cash":77.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPECTRANETICS LEAD CUTTER  518-0240","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1081.5,"discounted_cash":270.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DIAGNOSTIC CATHETER JL4 6FX100 .038 5 EA MIN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":89.99,"discounted_cash":22.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE KIT RETRIEVAL RADIOPAQUE LOOP SRK30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5360.95,"discounted_cash":1340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM BIOPSY LIVER TRANSJUGULAR TL-18C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4429.0,"discounted_cash":1107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE, TROCAR DISPOSABLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":205.9,"discounted_cash":51.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 14FR 30CC 0166L14","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VAC VERAFLO DRESSING MEDIUM ULTVFL05MD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1054.62,"discounted_cash":263.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY EMMETT 3-WAY 24FR 0138L24","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":108.46,"discounted_cash":27.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET SIMPLICITY MICRO-PUNCTURE INTRODUCER SET 4FR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":582.98,"discounted_cash":145.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 4-18IN BLUE D/A BV-1 M8806","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":393.77,"discounted_cash":98.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER STYLET STRGHT EXTD TPR BALL - MEDTRONIC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH VELOCITY DELIVERY 2.6-2.95FX160CM MICROCATH-PENUMBRA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9523.57,"discounted_cash":2380.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH NEURO MIKAELSSON 4FX90CM .035 -ANGIODYNAMICS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":177.68,"discounted_cash":44.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER MIV 5FR 125CM RADIAL PRIGTAIL SHORT TIP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":190.86,"discounted_cash":47.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL PERIPH PENUMBRA DETACHMENT HANDLE - PENUMBRA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2420.5,"discounted_cash":605.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STYLET KIT .014 STR GRAY EXTND BALLLTIPX65CM - MEDTRONIC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOSTON SCIENTIFIC HEX WRENCH 7.6CM SC-4276 NEUROMODULATION","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP CARTO SYSTEM REFERENCE  PATCHES-BIOSENSE WEBSTER","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4501.1,"discounted_cash":1125.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE PACING LARGE 12IN REMINGTON 365888","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":459.9,"discounted_cash":114.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SWAN-GANZ THERMODILUTION CATH 5FX100CM J-TIP-E","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1257.23,"discounted_cash":314.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SMART ABLATE IRRIGATION TUBING SET","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":865.2,"discounted_cash":216.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 30IN BLUE D/A BV-1 8709H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":97.03,"discounted_cash":24.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIO TORCON 5FRX100CM .038 ADVANTAGE G47032","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":217.59,"discounted_cash":54.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BSCI CABLE EXTENSION 1 X 16MM 61CM SC-4116","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER ACCESSORY TORQUE WRENCH - BIOTRONIK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":459.9,"discounted_cash":114.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING PREVENA 13CM PRE1155US.S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2557.59,"discounted_cash":639.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL PERIPH AZUR DETACHMENT CONTROLLER - TERUMO","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1926.1,"discounted_cash":481.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH DIAG MIKAELSSON 5FX80CM .038 SOFT VU-ANGIODYNAMICS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":177.68,"discounted_cash":44.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRANSVENOUR PACING CABLE 6FT DISPOSABLE ADAP-2000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":267.49,"discounted_cash":66.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DIAGNOSTIC CATHETER JR3.5 6FX100 .038-CORDIS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":90.13,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DIAGNOSTIC CATHETER MPB 5FX100 .038-CORDIS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BIOPSY TLAB TRANSJUGULAR 19ga X 7F 60cm STRAIGHT CATH 5F CURVE CATH 5F TL-19","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4429.0,"discounted_cash":1107.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT OSTEOCOOL BONE ACCESS 090 10GA OCN002HB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4544.88,"discounted_cash":1136.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE NERVE STIMULATOR ENTRADA 11CM SC-4220-45","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1081.5,"discounted_cash":270.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CATHETER STYLET J BALL TIP .014IN 45CM 6094-45","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":346.08,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT NEUROSTIMULATOR CHARGING SYSTEM M365SC641230","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23436.0,"discounted_cash":5859.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE SUTURE RETENTION LOCKET 9301","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT STYLET J  L58CM OD.014 IN KNOB BALL TIP 6091-58CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":346.08,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TAMP SURGICAL EXPRESS KYPHX LOW PROFILE 2X10X21MM K15A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7539.12,"discounted_cash":1884.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC CATHETER ASPIRATION II AVENTUS 24FR 0.035IN 95CM AV24-95-M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT STIMULATOR PRECISION STYLET ENHANCED W/ STEERING CAP 50CM SC-4395-50","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ASPIRATION II AVENTUS 24FR 0.035X92CM AV24MAX-92-M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC STABILIZER PASCAL RAIL SYSTEM 20000STA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT HEMODIALYSIS SUPER HERO ETO STERILIZATION SUPERHERO","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36828.0,"discounted_cash":9207.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AVENTUS CLOT MANAGEMENT SYSTEM CMS-M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE INTERFACE CATHETER GENERATOR 10FT 305CM D133701","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7153.94,"discounted_cash":1788.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE PACING DISP STER ROHS 12FT 5846VL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR VASCULAR COONS TAPER 10FR 20CM G03928","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR VASCULAR COONS TAPER 12FR 20CM G03929","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR VASCULAR MAC-LOC COONS TAPER 14FR 20CM G03932","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC SYRINGE IRRIGATION BORE LARGE DISP 60CC 99-102","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER PULMONARY ARTERY ARROW BALLOON WEDGE PRESSURE 7FR 110CM AI-07127","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1931.44,"discounted_cash":482.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSERTION NEEDLE SC-4205 5IN 13CM M365SC42050","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER IAB ARROW FIBEROPTIX 8FR 30CC IAB-05830-LWS-SC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8604.55,"discounted_cash":2151.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THERMODILUTION 4 LUMEN 7F 110CM TD2704NDF","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CASSETTE INFUSION PUMP PURGE GEN 2 1000200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER IAB ARROW FIBEROPTIX 8FR 50CC IAB-05850-LWS-SC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8604.55,"discounted_cash":2151.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CATHETER ASAHI FUBUKI 5X80CM 6FR WAIN-FBK-6SD80","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VESSEL FLEX PREP SYSTEM 75CM FSC4-75","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17974.95,"discounted_cash":4493.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT ANGIOGRAPHY HAND CONTROLLER AT X65I 019499","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":659.2,"discounted_cash":164.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE CONNECTOR CATHETER ENSITE X EP 365CM D-ENS-AVHDXCBL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8559.5,"discounted_cash":2139.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE CATHETER RESPONSE EXTENSION BLACK ELECTROPHYSIOLOGY 210CM 401976","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":318.27,"discounted_cash":79.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA RADIOFREQUENCY VENOM OD20 GA 10X100MM 0406-660-125","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1009.06,"discounted_cash":252.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR ROTATABLE MDT 5944RL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3296.0,"discounted_cash":824.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DIAGNOSTIC CATHETER MPA2 5FX100 .038-CORDIS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR VASCULAR COONS TAPER 8FR 20CM G03927","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE CATHETER FARASTAR CONNECTION PFA RX M004PF41M434","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE HEMOSTATIC ROTATIONAL 0.096IN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CATHETER RIGHT/LEFT CORONARY/VENTRICULAR PIGTAIL 6FR MULTIPAC 145DEB 532-685N","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":261.96,"discounted_cash":65.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER STP AL1 6FR 100CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":90.13,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC ELECTRODE FIXATION PINCH-ON TOOL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT STYLET BALLED TIPPED","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC STYLET TAPERED BALL TIP EXTERNAL 6082-58","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER STP ANALYTICAL REAGENT MODIFIED 6FR 100CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":81.89,"discounted_cash":20.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR COONS 20F X 20CM .038-COOK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":296.13,"discounted_cash":74.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR VASCULAR COONS TAPER 22FR 20CM .038IN G04443","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":296.13,"discounted_cash":74.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTROPHYSIOLOGY COOL POINT TUBING-ST JUDE/DIAGDIVISION","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FILTER SPIDER FX 5.0 MM- EV3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8568.51,"discounted_cash":2142.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FILTER SPIDER FX 6.0 MM - EV3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8568.51,"discounted_cash":2142.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FILTER SPIDER FX 7.0 MM - EV3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8568.51,"discounted_cash":2142.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC SLITTER ADJUSTABLE MEDTRONIC 6232ADJ","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE 6FR. 30MM X 120 CM AMPLATZ GOOSENECK - EV3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2760.4,"discounted_cash":690.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP CRYOCATH ELECTRICAL UMBILICAL TUBING-CRYOCATHtechnologies","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP CRYOCATH CO-AXIAL UMBILICAL TUBING-CRYOCATH TECHNOLOGIES","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1957.0,"discounted_cash":489.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"G TUBE GASTROSTOMY STOMA MEASURING DEVICE-KIMBERLY CLARKE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":86.73,"discounted_cash":21.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE CATHETER CARTO SPLIT HANDLE EXTEND LG 10IN D134402","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11028.24,"discounted_cash":2757.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE CATHETER HYPERTONICS 12 PIN YELLOW 10 FT CY1212CT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1804.24,"discounted_cash":451.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOADING SYSTEM EVOLUT FX L-EVOLUTFX-2329","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2987.0,"discounted_cash":746.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACC INZONE 2.0 DETACHMENT SYSTEM -STRYKER","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2719.2,"discounted_cash":679.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADAPTER FEEDING TUBE MIC-KEY SET 18FR 3CM 8140-18.3.0","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":938.95,"discounted_cash":234.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ESOPHAGEAL ENSOETM TEMP MANAGEMENT DEVICE ECD02-A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6982.75,"discounted_cash":1745.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE CATHETER EXTENSION D135703","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4177.88,"discounted_cash":1044.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING R2P DESTINATION SLENDER 6FR 105CM GS-R6ST1C10W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2657.4,"discounted_cash":664.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING R2P DESTINATION SLENDER 6FR 95CM GS-R6ST1C95W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2657.4,"discounted_cash":664.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER VASCULAR ZOOM LARGE .088X.110IN 100CM ICTC088100S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":26742.15,"discounted_cash":6685.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER VASCULAR ZOOM LARGE 6FR .088IN 100CM ICTC088110","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":26742.15,"discounted_cash":6685.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC DEVICE INFLATION ATRION QL 29MM 38ML LOCK SYRINGE 96406","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC EDWARDS CRIMPER 9600CRA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC KIT STYLET STRAIGHT KNOB BALL BLUE TIP .014IN 52CM 6057-52","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE COMPRESSION SAFEGUARD PRESSURE ASSIST HEMOSTASIS 24X12.8X2.5CM 82000/D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":589.47,"discounted_cash":147.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CATHETER IMPLANTATION DIALYSIS VP-511","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1957.0,"discounted_cash":489.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE PACING SJM TEMPORARY EXTENSION DISPOSABLE 12FT 4051L","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE PACING SAFE-CONNECT 12FT S-101-97-12","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.25,"discounted_cash":57.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRENCH PACEMAKER 2 BIDIRECTIONAL TORQUE 6628","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC PERFORMA PEBAX POLYCARBONATE MOT 5FR 65CM 5591-A3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":100.12,"discounted_cash":25.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL TUNNELING 3.1X338MM 6996T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC CARDIAC CARDIOMEMS WIFI ADAPTER CM3040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE INFLATION BASIXTOUCH POLYCARBONATE ANALOG 13IN 30ML IN8852","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":428.48,"discounted_cash":107.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC HAWKONE DIRECTIONAL ATHERECTOMY BATTERY PACK H1-14550","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE PACING SURGICAL DISP 301-CG","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":243.9,"discounted_cash":60.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STYLET LEAD STRAIGHT SOLIA S 60CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":459.9,"discounted_cash":114.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL FIXATION DH STERILE LATEX FREE DISP 331668","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":459.9,"discounted_cash":114.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAP LEAD PACER CONNECTOR 26MM BK-IS 109185","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":459.9,"discounted_cash":114.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ELECTROPHYSIOLOGY SUPREME 6FR 5MM 120CM 401442","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1019.7,"discounted_cash":254.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SAFEGUARD FOCUS COOL COMPRESSION DEVICE 17X15CM 120ML SGF1A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM DELIVERY CATHETER EVOLUT FX 34MM TAV D-EVOLUTFX-34","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14055.6,"discounted_cash":3513.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM LOADING EVOLUT FX 34MM TAV L-EVOLUTFX-34","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2987.0,"discounted_cash":746.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC STYLET J EXTEND TAPER BALL TIP KNOB GRAY KIT .014IN 53CM 6091-53","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHERTER LITHOTRIPSY L6 8X30MM L6IVL080030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28876.5,"discounted_cash":7219.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC AUROUS PIGTAIL 5FR 100CM G47308","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":944.51,"discounted_cash":236.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONCRYL 3-0 PS-1 UNDYED 27IN Y936H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER DA VINCI SUREFORM 45 CURVED TIP 480545","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5620.44,"discounted_cash":1405.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DISSECTOR SONICISION 39CM CURVED JAW ULTRASONIC SCDA39","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5770.36,"discounted_cash":1442.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMO-LOK MED-LRG 471327","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":25.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR 5.0MM CARBIDE ROUND #5 5820-110-050C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2675.12,"discounted_cash":668.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COR-NOT MINI DEVICE 17CMX4MM 031300","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":952.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BONE PREP SMALL WITH CEMENT BIO 0206-703-011","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":995.7,"discounted_cash":248.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE SURGICAL SKIN CLOSURE 24IN PS1240","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTERSTIM FORAMEN NEEDLE 12.6IN 041839","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INSTRUMENT ORTHOLOCK 2 JOINT PREP 9914PK01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2173.3,"discounted_cash":543.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AGENT HEMOSTATIC CELLERATERX SURG PWDR 5G WCI-05-SACRXP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12568.95,"discounted_cash":3142.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL PRECISION MATCH HEAD 3.0MM 8450-107-530","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2493.77,"discounted_cash":623.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGICLIP EXTRA SMALL MULTI LT102","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":347.42,"discounted_cash":86.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LIGACLIP EXTRA MEDIUM OPEN/ENDO MULTI LT202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":411.59,"discounted_cash":102.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE MINERVA ES CONTROLLER STR DISP MIN9770","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS DA VINCI XI CADIERE 8MM 471049","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1622.25,"discounted_cash":405.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS DA VINCI XI PROGRASP 8MM 471093","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1622.25,"discounted_cash":405.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE DRIVER DA VINCI XI ENDOWRIST LARGE 8MM 471006","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1838.86,"discounted_cash":459.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE DRIVER DA VINCI XI SUTURECUT LARGE 8MM 471296","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1311.5,"discounted_cash":327.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE DRIVER DA VINCI XI SUTURECUT MEGA 471309","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1893.14,"discounted_cash":473.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS DA VINCI XI MARYLAND BIPOLAR 8MM 471172","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2541.94,"discounted_cash":635.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS DA VINCI XI FENESTRATED BIPOLAR 8MM 471205","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRASPER DA VINCI XI BIPOLAR LONG 471400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3136.35,"discounted_cash":784.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS DA VINCI XI FORCE BIPOLAR 471405","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2541.53,"discounted_cash":635.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT CAROTID OUTLYING 8FR X 31CM W/T-PORT E2013-10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11703.99,"discounted_cash":2926.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR ONETRAC LXD 30X15 C100270","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT QUICK COUPLINE CANNULATED 2.0X145 03.333.101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5369.24,"discounted_cash":1342.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PERFORM HUMERAL GUIDE PIN MWM100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1609.27,"discounted_cash":402.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MATCH HEAD MR8 14CM 3MM MR8-14MH30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1717.32,"discounted_cash":429.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MATCH HEAD MR8 15CM 2.2MM MR8-15MH22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1824.75,"discounted_cash":456.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIO-MEDICUS NEXTGEN CANNULA FEMORAL 21FR 96600-121","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4156.26,"discounted_cash":1039.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL CANN HOLLOW LARGE 16MM 03.037.004S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8569.14,"discounted_cash":2142.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL VALOR 4.3MM 415S002350","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER SURGICAL VALOR 9X250MM 4150002090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3388.7,"discounted_cash":847.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER HEAD VALOR FLEXIBLE 9.0MM 4150006090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":798.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER HEAD VALOR FLEXIBLE 9.5MM 4150006095","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":798.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER HEAD VALOR FLEXIBLE 10.0MM 4150006100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":798.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER HEAD VALOR FLEXIBLE 10.5MM 4150006105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":798.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER HEAD VALOR FLEXIBLE 11.0MM 4150006110","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":798.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MR8 ACRON 19CM 9MM MR8-9AC90","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1824.75,"discounted_cash":456.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MIDAS REX MR8 TAPERED 2.3MM 7CM MR8-F2/7TA23","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1520.59,"discounted_cash":380.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MIDAS REX MR8 ACORN 9CM 6MM MR8-9AC60","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1824.75,"discounted_cash":456.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MELZI SHARPS FINDER 45CM 5MM FG70003-5P","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX MONOCRYL PLUS 3-0 KNOTLESS 24IN SXMP1B103","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":214.98,"discounted_cash":53.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE TAPE TIGERLINK WHITE/BLACK 0.9MM AR-7559T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS DA VINCI XI LONG TIP 8MM 471048","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1352.18,"discounted_cash":338.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1352.18,"discounted_cash":338.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL CARBIDE MATCH HEAD 3MM 5820-107-530C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2658.64,"discounted_cash":664.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE TOCAR 1PKG 1.1X100MM A-5040.10/1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":298.7,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON FEMORAL PROCEDURE KIT SZ 1 5555-2201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1506.38,"discounted_cash":376.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON FEMORAL PROCEDURE KIT SZ 2 5555-2202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1506.38,"discounted_cash":376.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON FEMORAL PROCEDURE KIT SZ 3 5555-2203","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1506.38,"discounted_cash":376.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON FEMORAL PROCEDURE KIT SZ 4 5555-2204","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1506.38,"discounted_cash":376.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON FEMORAL PROCEDURE KIT SZ 5 5555-2205","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1506.38,"discounted_cash":376.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON FEMORAL PROCEDURE KIT SZ 6 5555-2206","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1506.38,"discounted_cash":376.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON FEMORAL PROCEDURE KIT SZ 7 5555-2207","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1506.38,"discounted_cash":376.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON TIBIAL PROCEDURE KIT SZ 1 5555-2321","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1255.36,"discounted_cash":313.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON TIBIAL PROCEDURE KIT SZ 2 5555-2322","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1255.36,"discounted_cash":313.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON TIBIAL PROCEDURE KIT SZ 3 5555-2323","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1255.36,"discounted_cash":313.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON TIBIAL PROCEDURE KIT SZ 4 5555-2324","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1255.36,"discounted_cash":313.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON TIBIAL PROCEDURE KIT SZ 5 5555-2325","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1255.36,"discounted_cash":313.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON TIBIAL PROCEDURE KIT SZ 6 5555-2326","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1255.36,"discounted_cash":313.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRIATHLON TIBIAL PROCEDURE KIT SZ 7 5555-2327","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1255.36,"discounted_cash":313.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLEEVE SURGICAL WIRE 1.6MM 323.055","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2177.42,"discounted_cash":544.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DA VINCI SPATULA ENDOWRIST MONO PERM CAUTERY 471184","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT SUTURE REMOVAL DURASTAT GZL-002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8018.9,"discounted_cash":2004.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT CAROTID FLEXCEL STRAIGHT 10FR 13CM 2020-25","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDESCOPE BRONCH BFLEX-2 3.8MM SLIM 0570-0448","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2672.85,"discounted_cash":668.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONTROL REMOTE PATIENT 2301","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7595.43,"discounted_cash":1898.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA VENOUS FEMORAL ADULT 21FR 55CM 96670-121","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3666.8,"discounted_cash":916.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA VENOUS FEMORAL ADULT 25FR 60CM 96670-125","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3666.8,"discounted_cash":916.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE V-LOC 180 UNDYED 12 V-20 TAPER VLOCL0615","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":240.2,"discounted_cash":60.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":240.20,"discounted_cash":60.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP APPLIER 12MM LARGE DISP ER420","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":561.8,"discounted_cash":140.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HARMONIC ACE+7 SHEARS WITH HEMOSTASIS HARH23","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3685.55,"discounted_cash":921.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER 29mm POWERED CIRCULAR GRIP TECH 3D CDH29P","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.82,"discounted_cash":901.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALANT FIBRIN TISSEEL PRIMA FROZEN 10ML 1506080","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4103.52,"discounted_cash":1025.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE SP PLASMABUTTON WA22657S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4723.99,"discounted_cash":1181.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER DA VINCI XI ANGLED 30mm 470530","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1557.36,"discounted_cash":389.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"7mm SPANNER WRENCH 4920-9-036","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":772.29,"discounted_cash":193.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ION ENDOLUMINAL 23G BIOPSY NEEDLE 490102","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11262.5,"discounted_cash":2815.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX PDS PLUS 0 CT-1 12IN VIO SXPP1A433","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":249.7,"discounted_cash":62.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT NAIL 3mm K-WIRE 4150004025","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2358.7,"discounted_cash":589.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT NAIL VALOR DRILL SHORT 4.3mm 415S002351","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 2-0 NON-ABSORB FSLX BLACK 1674H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.98,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE SP PLASMABAND 12D WA22623S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4499.04,"discounted_cash":1124.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE PINS 4.0x140mm 144140","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":626.65,"discounted_cash":156.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VLOC BLUE L9 IN 37mm GS21 NON-ABSORB NEEDLE VLOCN0346","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":293.76,"discounted_cash":73.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD SUREFORM 60 4.6MM BLACK 48360T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2487.45,"discounted_cash":621.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE SINGLE ENDED TROCAR TIP SMOOTH 1.6x150mm P99-192-1615","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":199.00,"discounted_cash":49.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRATAFIX 1 SYMMETRIC PDS PLUS VIO 56CM SXPP1A400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":206.50,"discounted_cash":51.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRATAFIX SYMMETRIC PDS PLUS 45CM CT-1 SXPP1A404","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":214.83,"discounted_cash":53.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT INBONE SZ 2mm 200178002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE STRATFIX PDS PLUS 2-0 70cm VIOL SXPP1B412","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":233.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBULOCK IMPLANT SYSTEM AR-8973DS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6307.0,"discounted_cash":1576.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW SAGITTAL 100X19X1.27MM BR1-19100-50","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":259.56,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW SAGITTAL DUAL CUT 75X18X0.89MM BR4118-089-075","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":238.96,"discounted_cash":59.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE THIN 9.0x0.38x25mm 2296-003-511","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":213.62,"discounted_cash":53.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBERTAK RC DISPOSABLES KIT AR-3650DS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MAKO KNEE TIBIAL CHECKPOINT STERILE 111651","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":506.76,"discounted_cash":126.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHECKPOINT KIT STERILE 111645","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":233.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW MAKO STANDARD DISP 116170","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1781.80,"discounted_cash":445.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE NARROW MAKO DISP 116171","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1781.80,"discounted_cash":445.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT NAIL VALOR DRILL LONG 4.3mm 415S002352","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX 3-0 SPIRAL MONO PLS UNDYE 20CM SH SXMP1B427","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":225.98,"discounted_cash":56.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX 0-0 SPIRAL PDS PLUS VIO 30CM CT-1 SXPP1B450","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":237.06,"discounted_cash":59.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE DAVINCI SYNCHROSEAL BIOLAR 5mm DISP 480440","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6527.75,"discounted_cash":1631.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER DAVINCI SUREFORM 45 480445","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4974.9,"discounted_cash":1243.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE FLAT 12MMx5CM SINGLE USE SBLDFLAT-5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE CURVED FOR MEDIAL HIP 12MMx11CM SINGLE USE SBLDCURVE-3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":437.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE FENESTRATION PEFORATOR P99-100-2010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1468.78,"discounted_cash":367.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SMALL-JOINT FULL RADIUS 3.5mm 80mm CUTTER 0375-637-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLICATOR TIP LAPAROSCOPIC VISTASEAL VSTL35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":895.89,"discounted_cash":223.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VLOC 180 3-0 9IN V-20 MONO VLOCL0644","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUREFORM 45 RELOAD STAPLER 2.5 WHITE 6 ROW 48345W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHARGER NEUROSTIMULATOR 1401","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8109.0,"discounted_cash":2027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUREFORM 45 RELOAD STAPLER  3.5 GREEN 6 ROW 48345G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX 0-0 SPIRAL PDS PLUS 22CM CT-1 SXPP1B455","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":238.78,"discounted_cash":59.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHAVER TRUCLEAR SOFT TISSUE PLUS DISP 7209509","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4296.13,"discounted_cash":1074.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR CERVICAL DILAPAN-S 4x55mm 0455","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":741.6,"discounted_cash":185.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS ANTIBACTERIAL POLYDIOXANONE 2-0 RB-1 D10102","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":523.63,"discounted_cash":130.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRATAFIX SYMMETRIC PDS PLUS KNOTLESS 23CM CT-1 SXPP1A425","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":250.72,"discounted_cash":62.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRATAFIX SPIRAL PDS PLUS KNOTLESS 0 CT-1 SXPP1B405","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":237.11,"discounted_cash":59.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRATAFIX SPIRAL PDS PLUS KNOTLESS 3-0 SH-1 SXPP1B420","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":277.13,"discounted_cash":69.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FASTENER LAPAROSCOPIC FIXATION PEEK HELICAL 0113215","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3316.6,"discounted_cash":829.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE TIBIA SYSTME T2 1806-1417S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1089.74,"discounted_cash":272.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELASTIC NAIL INSERTION SLEEVE SPI 08-11 1806-1406S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1146.6,"discounted_cash":286.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELINE MAS NEEDLE AND PUSHER 2PF FEN 10001121","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6487.2,"discounted_cash":1621.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX SPIRAL PDS PLUS VIO 2-0 SH 30CM SXPP1B416","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":235.75,"discounted_cash":58.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FLAT BLADE 11x50mm 10-101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VAPOENUCLEATION BIPOLAR ELETRODE 24/26FR 27040VE-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4541.06,"discounted_cash":1135.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FLAT TIP BLADE 11x100mm 10-105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUREFORM 45 RELOAD STAPLER 3.5 BLUE 6 RO 48345B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUREFORM 45 RELOAD STAPLER 4.6 BLACK 6 ROW 48345T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD SUREFORM 60 4.3MM GREEN 48360G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2487.45,"discounted_cash":621.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEUROSTIMULATOR W/COMMUNICATOR HANDSET KIT TH90Q01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL ROUND 8 FLUTE 55X2.4MM 1608-002-009","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":327.54,"discounted_cash":81.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 1 36IN CTX #J977H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13.90,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOADING UNIT LINEAR CUTTER 75MM STAPLES TITANIUM #TCR75","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":550.02,"discounted_cash":137.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CUTTER LINEAR W/SAFETY LOCK-OUT 55MM DISP #TLC55","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":691.16,"discounted_cash":172.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL LINEAR CUTTER 75MM 52/EA TITANUM #TLC75","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1031.48,"discounted_cash":257.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL PROXIMATE RELOADABLE BLUE 60MM #TX60B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":703.01,"discounted_cash":175.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE PREPARATION KIT CEMENT INJ SYSTEM 0206-710-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":985.92,"discounted_cash":246.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN SILICONE ROUND HUBLESS 19FR W/O TROCAR #B072230","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":110.52,"discounted_cash":27.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GUT PL 6-0 OPHTH 18IN G-1G-1 #770G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":118.35,"discounted_cash":29.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 1 CTX  30IN #8455H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18.85,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEPUY KNEE FIXATION PINS THREADED 6PACK 9505-02-089","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 18FR 5CC 2WAY COUDE BARDEX LUBRICATH 0168L18","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":71.89,"discounted_cash":17.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 1 CT-1 8425","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.09,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NUROLON 2 27INCH TIES X8 WHITE D4265","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":413.85,"discounted_cash":103.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 6-0 PLASTIC 18IN P-3 #1698G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.07,"discounted_cash":5.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 4-0 CUTICULAR 18IN FS-2 #662H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11.74,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 5-0 PLAST.18IN P-3 36/BX #698H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.97,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 2-0 27IN CT-2 #VCP269H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.50,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":14.63,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE QUICK-CORE BIOPSY 18G 20T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":557.44,"discounted_cash":139.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VCRYL UN BR 2-0 NURO 8-18INCP-2 COMP #J762D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":112.48,"discounted_cash":28.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 2-0 CLOS 8-18 CR/CT-1 #J839D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":86.31,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND EX GRN BR O CLOSURE 8-18IN CR CT-2 #CX27D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":79.83,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL ENDOSCOPIC CIRCULAR 33MM #ECS33A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2710.48,"discounted_cash":677.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR ENDOPATH W/BLADE BLUNT TIP 12MM X 100MM L #H12LP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.13,"discounted_cash":44.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLEDGETS PTFE POLYMER PRE-PUNCHED 8677-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":225.26,"discounted_cash":56.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT SHOULDER SPIDER STABILIZATION 7210573","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":582.88,"discounted_cash":145.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE MAYO #4  #1824-4DC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":24.12,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MANIPULATOR UTERINE CONMED V-CARE SMALL 60-6085-200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":509.03,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBING SET TISSEEL EASY SPRAY #0600065","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":495.53,"discounted_cash":123.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ENDOSCOPY SUCTION IRRIGATOR STRYKFLOW II 250-070-500","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":438.88,"discounted_cash":109.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":438.64,"discounted_cash":109.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOOPS VESSEL DEV-O-LOOP 2/PK RED 6202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW SAGITTAL 19MM X 41MM X .4MM #5023-182","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":614.91,"discounted_cash":153.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CUTIER RELOAD LINEAR BLUE 55MM #TCR55","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":370.39,"discounted_cash":92.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK BLK BR 4-0 LABYRINTH 12-18 #A183H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.32,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK BLK BR O LABYRINTH 6-30 #A306H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9.79,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL ENDOSCOPIC CIRCULAR 29MM #ECS29B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2707.25,"discounted_cash":676.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE CUSTOM 13X0.25X20MM 2296-003-102S2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":350.72,"discounted_cash":87.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS CLEAR MONO 4-0 PLASTIC 18IN PS-2 #Z496G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.07,"discounted_cash":10.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS MONO 1 36IN CT-1 #PDP347H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.18,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS O UD 27IN SH #VCP418H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":26.37,"discounted_cash":6.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL VIL BR 2-0 URL.27IN UR-6 #J602H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":15.56,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 2-0 SUTUPAK 12-18 #J911T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":60.56,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP LIGATING LIGACLIP LARGE LT400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":259.05,"discounted_cash":64.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE PNEUMOPERITONEUM LONG DISP #PN150","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":92.7,"discounted_cash":23.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL PROXIMATE RELOADABLE 30MM GRN #TX30G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":694.91,"discounted_cash":173.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL PROXIMATE RELOADABLE 60MM GRN #TX60G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":717.22,"discounted_cash":179.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND GRN BR 2-0 CLOSURE 30IN CT-2 #X411H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL PROXIMATE RELOAD BLUE 60MM #XR60B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":357.00,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":357.0,"discounted_cash":89.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL PROXIMATE RELOAD GREEN 60MM #XR60G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":354.46,"discounted_cash":88.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS UND 3-0 27IN PS-2 MCP427H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":43.05,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":43.03,"discounted_cash":10.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 5-0 18IN P-3 #MCP495G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.95,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 4-0 27IN RB-1 #PDP304H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS VIL MONO 3-0 UROLOGICAL 27IN RB-1 #Z305H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.40,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":20.39,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 3-0 27IN MONO SH #PDP316H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.50,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS VIL MONO O OB.-GYN.36IN CT-1 #Z346H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.68,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":19.67,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS CLEAR MONO 3-0 CUTICULAR 27IN FS-1 #Z442H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":27.71,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL CARBIDE TAPER SIDE CUT 45X2.1MM 1607-002-109","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":85.8,"discounted_cash":21.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE MICRO LONG/WIDE OFFSET TEETH 2296-003-106S3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":690.92,"discounted_cash":172.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER K-WIRE 3.2X450MM STERILE #1210-6450S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1565.6,"discounted_cash":391.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET K WIRE 2.0MM SS KW20SS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":256.78,"discounted_cash":64.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIXATION PINS FLUTED HEADLESS 1/8x3.5IN MM STER BMA-S90010S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":170.57,"discounted_cash":42.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA AORTIC EXTENDED SOFTFLOW 7MM 21FR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":764.78,"discounted_cash":191.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"*DO NOT**DUP,USE 045344*MIXER CEMENT REVOLUTION W/FEM NOZZLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1210.25,"discounted_cash":302.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE TROCAR TWO PART 18GA 20CM ECHOTIP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":231.03,"discounted_cash":57.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER SMOOTH ROUND MODERATE PLUS 350CC 12.1CM 351-2350SZ","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE BALL TIP 1MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1468.16,"discounted_cash":367.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KWIRE 0.045IN X 160MM 07-40281","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":249.26,"discounted_cash":62.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 2.7MM 125MM 310.28","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":749.22,"discounted_cash":187.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 5-0 C-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":319.71,"discounted_cash":79.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT QUICK COUPLE 2.8MM PERCUTANEOUS 324.214","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 2-0 SH-1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":435.38,"discounted_cash":108.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT QUICK COUPLING 4.3 X 180MM   #310.431","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1140.72,"discounted_cash":285.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1140.73,"discounted_cash":285.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 3-0 30 INCH BLUE SH-1  #8762H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.30,"discounted_cash":10.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 4-0 36 INCH BLUE RB-1  #M8557","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":173.56,"discounted_cash":43.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ATRIUM PVC THORACIC 28FR  #8028","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":51.40,"discounted_cash":12.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":50.26,"discounted_cash":12.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 3-0 RB-1 #8558H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.54,"discounted_cash":10.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":42.54,"discounted_cash":10.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE INFLATION COOK SPHERE 30 ATM 20ML G25571","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":592.15,"discounted_cash":148.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE STRATAFIX PDS PLUS CT-1 24IN SXPP1A443","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":256.86,"discounted_cash":64.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADAPTER CATHETER LUER LOCK LL-1C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":31.72,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GORE-TEX CV-4 36 TH-18 4N02A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":359.68,"discounted_cash":89.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RING DURAN ANCORE W/CHORDAL GUIDE 27MM  620RG-27","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8784.75,"discounted_cash":2196.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RING DURAN ANCORE W/CHORDAL GUIDE 31MM 620RG-31","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8784.75,"discounted_cash":2196.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RING DURAN ANCORE W/CHORDAL GUIDE 33MM 620RG-33","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8784.75,"discounted_cash":2196.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RING DURAN ANCORE W/CHORDAL GUIDE 35MM 620RG-35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8784.75,"discounted_cash":2196.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA VENOUS TWO STAGE 29/37FR 91229C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":315.49,"discounted_cash":78.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 2.7 X 125MM QUICK CONNECT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1071.3,"discounted_cash":267.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 2.0 X 125mm QUICK COUPLE #310.21","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":751.08,"discounted_cash":187.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 0 EXCEL GRN BRD CT-2 SA CX27D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":79.83,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":79.82,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES K-WIRE 1.0 X 150MM TROCAR PT.","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":82.09,"discounted_cash":20.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR GISH 1/2 X 3/8 INCH  Y","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":46.66,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER RETROGRADE CARDIOPLEGIA 14FR  #RC2014","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1146.29,"discounted_cash":286.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT QUICK COUPLING DEPTH MARK 2.0X140MM 323.062","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1384.42,"discounted_cash":346.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1384.42,"discounted_cash":346.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND EXCEL 2-0 30 INCH (X10) GRN/WHT DLB ARM SH-1.","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3316.81,"discounted_cash":829.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE 1.37MM THK 18MM WD 90MM LNG 6118137090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":494.71,"discounted_cash":123.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE 0.89MM THK 18MM WD 75MM LNG 6118-089-075","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":494.71,"discounted_cash":123.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"1.9 ZERO TIP NITINOL RETVL BSKT 120CM #390-105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1889.54,"discounted_cash":472.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR ENDOPATH XCEL BLADELESS 12MMX150MM  B12XT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":220.16,"discounted_cash":55.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 3-0 30IN  BLU MONO SA FSL 8675H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.01,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA VEIN IRRIGATION VIC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":127.10,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA FEM ARTERIAL EDWARDS FEM-FLEX II20FRX15CM FEMII020AS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2397.12,"discounted_cash":599.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PERFUSION ADAPTER MEDTRONIC DLP 0.25INCH  10007","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.69,"discounted_cash":10.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CASPAR DISTRACTOR PIN 12MM FF912SB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":451.14,"discounted_cash":112.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLICATOR ENDOSCOPIC DUPLOSPRAY MIS  0601129","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":890.33,"discounted_cash":222.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 7-0 24INCH BV-1 X2 M8702","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":395.42,"discounted_cash":98.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN DAVOL HUBLESS SILICON FLAT 7MM X 20 CM JP  0070430","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":46.35,"discounted_cash":11.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER BURR OVAL MEDIUM 5.0MM 5300-10-513","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":132.56,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE 1.27MM THK 25MM WD 100MM LNG 6125-127-100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":494.71,"discounted_cash":123.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET HIP ACETABULAR DRILL BIT 3.2X30MM  31-323230","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STEEL 6 4 X 18IN CV-320 45CM  2224-69","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":144.00,"discounted_cash":36.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND EXCEL 2-0 30INCH GREEN SH-1  #MX763","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":115.77,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR Y 3/8 X 3/8 X 1/4 INCH   050527000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":48.82,"discounted_cash":12.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER TOURNIQUET CUFF DISP 44 INCH BLACK  5921-044-235","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":299.63,"discounted_cash":74.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE BD MICRO-SHARP 5.0MM  15 DEGREE   377515","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":31.31,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER CONTOUR CURVED CUTTER GREEN  CS40G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2953.53,"discounted_cash":738.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER RELOAD CURVED CUTTER GREEN GCR40G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1644.7,"discounted_cash":411.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT ANKLE STEINMAN PIN 2.4MM  200072","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT CANNULATED Q/C 3.2X170MM  310.65","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER HOOD PEEL AWAY 408-800-100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":352.88,"discounted_cash":88.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND XL 2-0 36 INCH GREEN HM X2  X843","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36.26,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER DRILL GAMMA3 4.2 X 300MM  1320-3042S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":566.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET HIP ACETABULAR DRILL BIT 3.2X20MM  31-323220","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD SUREFORM 60 3.5MM BLUE 48360B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2487.45,"discounted_cash":621.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER DAVINCI SUREFORM 60 480460","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER K-WIRE 1.2MM L65MM WITH OLIVE XBR001002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1400.8,"discounted_cash":350.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER BLADE SHORT NARROW 11.5 X 5.5MM 2296-033-410","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.36,"discounted_cash":54.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER PERSONA HEX SCREW 2.5 X 25MM 42-5099-025-25","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KYPHON TROCAR WITH DIAMOND SIZE 3 T15J","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7614.44,"discounted_cash":1903.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET DRILL BIT 3.2MM 405883","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULAE CORONARY PERFUSION SOFT TIP MODIFIED 30055","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":244.21,"discounted_cash":61.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING NEGATIVE PRESSURE ABTHERA W/SENSATRAC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4586.18,"discounted_cash":1146.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOSTAT SURGICAL SNOW ABSORBABLE 2 X 4IN 2082","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1600.41,"discounted_cash":400.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PASSER SUTURE QUICKPASS LASSO TIGHT CRV RT 25D AR-6068-25TR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":412.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCISSOR MICROLINE ENDO DISPOSABLE TIP 19.3MM 3142","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":345.05,"discounted_cash":86.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":345.28,"discounted_cash":86.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET DRILL BIT 2.7MM 405889","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER VENT LEFT HEART 10FR 12110","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":208.58,"discounted_cash":52.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 2-0 30IN BLACK SH 75CM C016D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":67.57,"discounted_cash":16.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY SILICONE 3-WAY 22FR 30ML LATEX FREE 73022L","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":87.86,"discounted_cash":21.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI CLIP APPLIER MEDIUM LARGE 5MM 428053","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1369.9,"discounted_cash":342.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI SUCTION IRRIGATOR 5MM 428054","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":293.55,"discounted_cash":73.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI FORCEPS CADIERE 5MM 428055","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO BAG 3X6 SPECIMEN RETRIEVAL SYSTEM 25030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":423.12,"discounted_cash":105.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY URETHRAL SILICONE 24FR 3 WAY 73024L","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":87.86,"discounted_cash":21.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE EMG KIT WITH NEEDLE 8050015","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7883.75,"discounted_cash":1970.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE SPINE ROD BENDING DIGITIZER ARRAY 2040001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MYO/WIRE TEMP CARDIAC PACING WIRE LT ORANGE 2-0 8IN 027-525","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":145.95,"discounted_cash":36.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MYO/WIRE TEMP CARDIAC PACING WIRE WHITE 2-0 24IN 025-201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":178.5,"discounted_cash":44.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DRILL BIT 2.5MM AR-8943-30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 3-0 30IN BLACK FS-1 669H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA VENOUS 29FR THREE STAGE 91429","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":592.25,"discounted_cash":148.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 5-0 VIOLET 30IN RB-1 #PDP320H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":50.78,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":50.78,"discounted_cash":12.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER 10 HOLE PIN CLAMP FOR POSTS AND PINS 4921-2-060","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7262.06,"discounted_cash":1815.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER DRILL BIT 3.3MM 02.00024.118","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":977.99,"discounted_cash":244.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 4-0 27IN TF #J434H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15.76,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ENDOWRIST 45 #410370","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":216.3,"discounted_cash":54.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRACER POINTER AXIEM 9735317","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DRILL BIT 2.0MM AR-8944-22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE MAXCESS 4 SURGICAL ACCESS KIT 3241000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":3153.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 4-0 TF 1/2 CIRCLE 45CM N267H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18.54,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 4-0 TF-1--4 1/2 CIRCLE 45CM N272H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STYLET 14FR LUBRICATED INTUBATING IS14L","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18.95,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER DRILL BIT 4.3MM 02.00024.002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":890.54,"discounted_cash":222.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSERT CLAMP STEALTH FIBRA SIZE 5 A0G14","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSERT CLAMP STEALTH FIBRA SIZE 3 A0G13","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DRILL BIT CANNULATED 2.2MM AR-8737-35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BAG RETRIEVAL ESPINER ECOSAC 12MM 2000ML EMP 180 ECO","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BAG RETRIEVAL ESPINER ECOSAC 12MM 3100ML EMP 230 ECO","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE V-LOC 90 3-0 V-20 6IN VIOLET VLOCM0604","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE V-LOC 90 3-0 V-20 9IN UNDYED VLOCM2044","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD ECHELON STAPLER 60MM WHITE GST60W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1237.55,"discounted_cash":309.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1237.54,"discounted_cash":309.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD ECHELON STAPLER 60MM BLUE GST60B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1410.79,"discounted_cash":352.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLE RELOAD ECHELON 60MM GREEN GST60G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1410.79,"discounted_cash":352.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER ECHELON FLEX VASCULAR ADVANCE PLACEMENT TIP PVE35A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2953.63,"discounted_cash":738.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURING DEVICE CAPIO SLIM OPEN ACCESS  M0068318250","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5429.97,"discounted_cash":1357.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE V-LOC 180 0-0 ABSORBABLE WOUND 8LP VLOCA008L","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":810.61,"discounted_cash":202.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR SLEEVE ENDO THORACIC 10-12MM ROUND TIP TT012","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY BARDEX SILICONE 18FR 30CC 166818","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.02,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL PLUS 0 CT-1 27IN VIOLET MCP340H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.89,"discounted_cash":4.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 3-0 27IN UNDYED PS-1 MCP936H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FUNNEL KELLER 2 IMPLANT DELIVERY SYSTEM HA-005","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1499.68,"discounted_cash":374.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MIXING AND DELIVERY SYSTEM 3CC ABS-1000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1946.7,"discounted_cash":486.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MERSILENE 5-0 DOUBLE ARMED 12IN CTX WHITE RS22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":226.50,"discounted_cash":56.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GORE-TEX CV-5 TH-8 5N04A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":373.38,"discounted_cash":93.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA PERFUSION EZ GLIDE STRAIGHT 21FR 14IN EZS21A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":586.07,"discounted_cash":146.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"END CAP 5 X 50MM BLUE 5027-1-050","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":481.52,"discounted_cash":120.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE MODULE SPINAL NEEDLE SSEP 8050315","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8964.95,"discounted_cash":2241.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PARAGON28 DRILL BIT CANNULATED 2.9 X 140MM P99-110-2914","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1468.78,"discounted_cash":367.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PARAGON28 K-WIRE SINGLE TROCAR TIP 1.4X150MM P99-192-1415","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":199.00,"discounted_cash":49.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROGEL EXTENDED APPLICATOR SPRAY TIP 16CM PGEN00506","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT ANKLE FOOT 2.0 X 24MM 58850020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1163.9,"discounted_cash":290.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD ECHELON VASCULAR PLACEMENT TIP WHITE VASECR35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1430.60,"discounted_cash":357.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DAVINCI VESSEL SEALER 410322","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5360.95,"discounted_cash":1340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CELL SAVER BOWL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":827.5,"discounted_cash":206.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER  FOLEY LUBRICOIUS COAT 24FR 30CC INT IRR 0167L24","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.1,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOCATH BD 14GA X 5.25IN 382269","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":124.12,"discounted_cash":31.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CELL SAVER TUBING","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":158.11,"discounted_cash":39.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DURA HOOKS 1/4 ARC (FISH) 382800","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":313.43,"discounted_cash":78.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN ROUND SILICONE 15FR 3/16","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":101.15,"discounted_cash":25.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":101.14,"discounted_cash":25.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING PREVENA CUSTOMIZABLE 90CM PRE4055US.S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3285.91,"discounted_cash":821.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX REDEUCE PATIENT TUBING DISP AR-6421","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":278.1,"discounted_cash":69.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX REDEUCE PUMP TUBING DISP AR-6411","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":628.3,"discounted_cash":157.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE MAXCESS 4 DISPOSABLE 3240060","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":3153.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN WOUNDEVAC MED KIT 1/8IN 400ML","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":151.31,"discounted_cash":37.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN WOUND EVAG LG KIT 1/4 INCH 400ML #SU130-404D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":90.85,"discounted_cash":22.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM HEMOPRO2 VASOSHIELD HARVEST VH-4001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10620.54,"discounted_cash":2655.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER PULSAVAC PLUS WOUND SYSTEM 00-5150-475-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":310.03,"discounted_cash":77.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":310.01,"discounted_cash":77.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LSI CK COR-KNOT QUICKLOADS 030850","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX P/BOX TRIMANO KIT AR-1644","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CAPIO 0 PDS 48IN DOUBLE ARM M0068331371","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":449.49,"discounted_cash":112.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FOAM ABTHERA OPEN ABDOMEN KIT DRESSING","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3731.18,"discounted_cash":932.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VAC VERAFLO DRESSING LARGE ULTVFL05LG","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1980.9,"discounted_cash":495.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CELL SAVER RESERVOIR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":403.55,"discounted_cash":100.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 2 COATED VIO BRD 4-27IN TP-1 VCP849G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":65.3,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 4-0 30IN BLU MONO DA SH-1 8526H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 0 EXCEL GRN BRD  8-18IN CT-1 CX21D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":80.96,"discounted_cash":20.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND #5 30IN GRN BRD V-37 #MB66G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":119.89,"discounted_cash":29.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE 1/2 CIRCLE CUTTING SPRING EYE #3 #215603","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":63.76,"discounted_cash":15.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE 18GA INTRODUCER","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":164.8,"discounted_cash":41.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER TRISTAPLER TAN ENDO GIA 60MM VASCULAR LOAD EGIA60AVM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3496.23,"discounted_cash":874.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDLE SHORT EGIA STAPLER EGIAUSHORT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2587.05,"discounted_cash":646.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VLOC 90 2-0 6IN GS-22 VIOLET VLOCM2105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 3-0 36IN MH V-26 BLUE 8842H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.42,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR DRAINAGE BLAKE CARDIAC 2:1 BCC2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":183.44,"discounted_cash":45.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR DRAINAGE BLAKE CARDIAC STRAIGHT 1:1 BCC1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":178.40,"discounted_cash":44.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER REAMER SHAFT MODIFIED TRINKLE 8 X 510MM 0227-8510S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LAMELAS KNOT PUSHER MI-KP-001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16082.85,"discounted_cash":4020.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE PACING ATRIAL EXTENSION FAS-LOC DISP BLUE FL-601-97 B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BIOPSY 6 TRU-CUT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":129.78,"discounted_cash":32.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER K-WIRE LENGTH 150MM 390164","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":113.3,"discounted_cash":28.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BIOPSY 4 1/2 TRU-CUT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.61,"discounted_cash":54.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MERSILENE 5MM 12IN WHITE BP RS20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":59.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 7-0 24IN BLUE CV-1 8702H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.06,"discounted_cash":24.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NUROLON CT-2 26MM 0 BLACK 8STRAND 18IN/45CM C527D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":73.03,"discounted_cash":18.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE TRACHEOSTOMY SHILEY PLASTICIZER 7.5X10.8X25.4X74MM 6CN75H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":375.02,"discounted_cash":93.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE TRACH SHILEY CUFFED 8.5MM #8CN85A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":375.02,"discounted_cash":93.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 18FR 5CC SILASTIC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.02,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER COUNCIL TIP 16FR 5CC 0196L16  BARD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":134.11,"discounted_cash":33.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BAKER 16FR JEJUNOSTOMY","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3638.68,"discounted_cash":909.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD SUREFORM 60 2.5MM WHITE 48360W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2487.45,"discounted_cash":621.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLOPLAST MERIDIAN VAGINAL POSITIONING SYSTEM 52080","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4284.8,"discounted_cash":1071.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSERT CALMP STEALTH FIBRA SOFT 86MM LATEX FREE G-8655","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP APPLIER DA VINCI XI ENDOWRIST LARGE 470230","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":151.41,"discounted_cash":37.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP APPLIER DA VINCI MEDIUM-LARGE 470327","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":108.15,"discounted_cash":27.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP APPLIER DA VINCI XI SMALL 470401","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":302.82,"discounted_cash":75.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPLINT DOYLE II INTRANASAL AIRWAY SILICONE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":427.97,"discounted_cash":106.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT LOCKING SHORT 3.1 X 216MM 705031","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2791.3,"discounted_cash":697.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUCTION IRRIGATOR DA VINCI XI 8MM 480299","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2866.8,"discounted_cash":716.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT ANKLE 3.0MM AR-8943-36","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1184.5,"discounted_cash":296.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT SUNDT EXT CAROTID ENDARTERECTOMY 30CM 3-4MM NL8505076","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7417.57,"discounted_cash":1854.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT SUNDT EXT CAROTID ENDARTERECTOMY 3.5X4MM NL8505079","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7417.57,"discounted_cash":1854.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD TRI-STAPLE 30MM MED ARTICULATE STRAIGHT SIG30AMT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3244.09,"discounted_cash":811.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE STRATAFIX 45CM SPIRAL MONOCRYL CT-1 UNDYED 2-0 SXMP1B413","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.98,"discounted_cash":54.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW BUSA NO TOOTH 3.54X0.98 BR1-2590-47","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":259.56,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHELL SIGNIA POWER CONTROL SIGPSHELL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2725.59,"discounted_cash":681.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 2.0 X 100MM 310.19","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1025.57,"discounted_cash":256.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES K-WIRE 1.6 X 150MM 292.16","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":820.50,"discounted_cash":205.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":820.5,"discounted_cash":205.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD TRI-STAPLE 2.0 60MM BLACK SIG60AXT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4390.79,"discounted_cash":1097.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD TRI-STAPLE 2.0 CURVED 30MM TAN SIG30CTAVM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3720.77,"discounted_cash":930.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD TRI-STAPLE 2.0 CURVED 45MM TAN SIG45CTAVM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3942.63,"discounted_cash":985.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT DELIVERY SYSTEM F/DISTAL BICEPS BC AR-2260BC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE RELINE MAS NITINOL BLUNT THREAD 10000607","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER ENDO GIA UNIVERSAL SINGLE USE 12mm #030449","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1042.67,"discounted_cash":260.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE FIXATION LOW PROFILE ORTHOLOC 1.2X150MM 707091202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":216.3,"discounted_cash":54.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT CALIBRATED 3.2MM DISP 110017537","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1012.9,"discounted_cash":253.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GORE-TEC CV-0 SH 36IN 2N02A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT BONE MIXER MIXEVAC III 0206-015-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":447.23,"discounted_cash":111.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ENDOSCOPY SHAVER AGGRESSIVE+ 3.5MM 375-534-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ENDOSCOPY SHAVER AGGRESSIVE+ 4MM 375-544-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE 5.5MM AGGRESIV MENISCUS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ENDOSCOPY SHAVER RESECTOR 5MM 375-522-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES K-WIRE TROCAR POINT 1.25 X 150MM 292.12","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":820.50,"discounted_cash":205.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":820.5,"discounted_cash":205.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORD ELECTROSURGICAL BIPOLAR DP9400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1553.45,"discounted_cash":388.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT CANNULATED 5MM DISP AR-8770-02","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANSPACH DRILL BIT FLUTED ACORN 7mm L-7AC-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1477.02,"discounted_cash":369.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT AO STRYKER SCALED 2.6x220mm 703901","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2132.1,"discounted_cash":533.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL CANN MINI-MONSTER 2.3X3.5MM P99-110-2312","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1468.78,"discounted_cash":367.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OLIVE WIRE SMOOTH 1.4mm P99-200-1406","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":805.46,"discounted_cash":201.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REVERSE PERIPHERAL SCREW DRILL BIT MWJ126","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1106.43,"discounted_cash":276.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX ANGEL BMC KIT ABS-10062T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7505.33,"discounted_cash":1876.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER REVOLUTION THIN FLEXIBLE NOZZEL 0606515000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":773.74,"discounted_cash":193.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHOCKPULSE PROBE 3.76mm SPL-PDBX376","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5991.65,"discounted_cash":1497.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER ENDOWRIST DA VINCI XI 30MM 470430","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1470.84,"discounted_cash":367.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALER VESSEL DA VINCI EXTEND 480422-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5913.53,"discounted_cash":1478.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PORT ACCESS LOW PROF OPTICAL BLDLESS TIP 8X120 IAS8-120LP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":789.7,"discounted_cash":197.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE BONE SCAPEL STD BLUNT 25MM LF DISP MXB-25","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5011.77,"discounted_cash":1252.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER BLUE 45mm H3.6mm H1.5mm GST45B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1272.87,"discounted_cash":318.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER WHITE THIN H2.6mm H1mm GST45W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1272.87,"discounted_cash":318.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE SINGLE ENDED TROCAR TIP SMOOTH 1.1x150mm P99-192-1115","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":199.00,"discounted_cash":49.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD ENDOWRIST 30MM STAPLER GREEN 48630G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1848.03,"discounted_cash":462.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VLOC 90 WOUND CLOSURE DEVICE 23CM VLOCM2245","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS BIPOLAR HARDY BAYONET 8 1/2IN 19-1229AU","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":741.6,"discounted_cash":185.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET TUBING AND CORD MALIS 9190002RP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":456.97,"discounted_cash":114.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT 4.7MM CANNULATED CSS-072-47-SQ","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER ENDOWRIST STAPLER 30 6-ROW GRAY 2.0MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1848.03,"discounted_cash":462.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER RELOAD ENDOWRIST STAPLER 30  6-ROW BLUE 3.5MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1848.03,"discounted_cash":462.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1848.02,"discounted_cash":462.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER RELOAD ENDOWRIST 30 6-ROW WHITE 2.5MM 48630W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1848.03,"discounted_cash":462.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE GRIPPER SELF-RETRACTING DISP ME-GR1000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1416.25,"discounted_cash":354.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SOLID MEASURING LONG AO 2.4X140 P99-100-2414","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1468.78,"discounted_cash":367.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT CANNULATED 3/15IN SQ CONNECT 3.5X160 P99-110-3516","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1468.78,"discounted_cash":367.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE COR-KNOT QUICK LOAD 6 POUCH 030874","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":695.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"V-LOCK N-A POLYMER LIGATION CLIPS MEDIUM 51114V","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":75.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":326.02,"discounted_cash":81.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"V-LOCK N-A POLYMER LIGATION CLIPS 61114V LARGE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":326.15,"discounted_cash":81.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":302.0,"discounted_cash":75.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":326.2,"discounted_cash":81.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL PIN (4pk) TROCAR HEADLESS 75mm 00-5901-020-00","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3450.5,"discounted_cash":862.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COR-KNOT MINI DEVICE COMBO KIT 4MM DIA 17CM SHAFT 12  031350","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6892.65,"discounted_cash":1723.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSERT CLAMP STEALTH FIBRA SOFT 61MM WHITE DISP G-6155","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BRUSH INTRAMEDULLARY 14MM OD 0206-711-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":101.04,"discounted_cash":25.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEARS ENDO MINI ROTICULATOR UNIPOLAR 5MMX31CM 174301","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR THORACOPORT 11.5MM #179303","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":470.3,"discounted_cash":117.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 1 8-18IN COATED VIO BRD CTX ETVCP765D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":88.07,"discounted_cash":22.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE V-LOC 90 2-0 GS-22 VLOCM2145","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CHOLANGIOGRAM 7.5FR TIP 18IN LONG 20018-010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW INBONE BONE REMOVER IB200051","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM VENAPAX VESSEL HARVESTING VPX-4000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER OPEN INTERNAL STD CIRCULAR 22CM EEA31","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL INBOUND 6MM 200134","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2914.9,"discounted_cash":728.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING FLUTE MATCHSTICK 3MM DISP L-8NS-M-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1477.02,"discounted_cash":369.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROUTER SURGICAL FLUTE 16MM DISP A-CRN-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1124.76,"discounted_cash":281.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL TWIST 1.1MM ADG-11-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1334.88,"discounted_cash":333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING SHORT STR FLUTE ACORN 9.2MM DISP S-9AC-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1477.02,"discounted_cash":369.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROUTER SURGICAL FLUTE 2.5MM L-CRN-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1477.02,"discounted_cash":369.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING SHORT XCOARSE DIAMOND BALL 5MM S-5DX-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1334.88,"discounted_cash":333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL LONG STD STRAIGHT DIAMOND BALL 3MM L-3SD-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1334.88,"discounted_cash":333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BIO-MEDICUS INSERTION PED 96553","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":815.76,"discounted_cash":203.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER PURSTRING 65 20242","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1363.21,"discounted_cash":340.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW FALCON PRECISION EVOLVE 25X1.27X105 6725-127-105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2805.1,"discounted_cash":701.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2805.10,"discounted_cash":701.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER DRILL BIT NON-LOCKING SHORT 2.5 X 216MM 705025","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2842.8,"discounted_cash":710.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MATCHSTICK FLUTED 15CM MA15-8NS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2039.4,"discounted_cash":509.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DRILL SURG PROFILE MINI COMPRESSION AR-8737-47","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT SAW BLADE WIDE 200138108S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":607.7,"discounted_cash":151.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT SAW BLADE NARROW 200138107S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":607.7,"discounted_cash":151.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT PEG DRILL INBONE TALAR 4MM IB200020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1071.2,"discounted_cash":267.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETAINER VISCERA (FISH)","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":393.46,"discounted_cash":98.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE V-LOC 1 GS21 18 INCH BLUE VLOCN0327","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":270.07,"discounted_cash":67.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEARS HARMONIC ACE PLUS 5MM 36CM HARH36","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4196.74,"discounted_cash":1049.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADHESIVE SWIFTSET TOPICAL SKIN THSS6","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":319.3,"discounted_cash":79.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHORD-X LOOP AND SUTURE SYSTEM 2-0 12MM CXL-20-1812-12","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4748.3,"discounted_cash":1187.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHORD-X LOOP AND SUTURE SYSTEM 2-0 16MM CXL-20-1812-16","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4521.7,"discounted_cash":1130.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHORD-X LOOP AND SUTURE SYSTEM 2-0 20MM CXL-20-1812-20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4748.3,"discounted_cash":1187.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHORD-X LOOP AND SUTURE SYSTEM 2-0 24MM CXL-20-1812-24","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4521.7,"discounted_cash":1130.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHORD-X CHORDAL SIZER CXCS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER AMERICAN LAPAROSCOPIC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW FALCON PRECISION OSCILLATE TIP 6720-127-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2805.1,"discounted_cash":701.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL VARIAX 2.6 X 135MM 703691","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":437.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM MEPILEX SILVER 3 X 3IN 395290","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":57.68,"discounted_cash":14.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OBTURATOR DA VINCI XI BLADELESS OPTICAL 8MM DISP 470359","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":324.45,"discounted_cash":81.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WAND ELECTROSURG 2.5MM 60D DOME W/CABLE AC3525-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4703.29,"discounted_cash":1175.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLOSURE SKIN ZIPLINE PRELOC 4CM PS2040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE TAPE 1.3 WITH TAILS WHITE/BLUE AR-7500","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER CLIP DA VINCI XI HEM-O-LOL ML 5MM 478053","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":216.3,"discounted_cash":54.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCISSORS DA VINCI XI CURVED 5MM 478057","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRASPER DA VINCI XI CROCODILE 5MM 478059","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1405.95,"discounted_cash":351.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HOOK CAUTERY PERMANENT 5MM 478090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1622.25,"discounted_cash":405.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PORT SINGLE SITE FOR 8.5MM ENDOSCOPE 478065","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1622.25,"discounted_cash":405.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SAW BLADE 1.27MM THK 25MM WD 90MM LNG 6125-127-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":518.91,"discounted_cash":129.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLAMP EXTERNAL FIXATION 5 HOLE PIN 4922-2-240","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9451.49,"discounted_cash":2362.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRASPER BIPOLAR LONG DAVINCI XI 470400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2987.0,"discounted_cash":746.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR BLADED 12MM STANDARD SMOOTH B12STS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":906.81,"discounted_cash":226.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 4/0 27IN VIOLET RB1 PDP304H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUCKER INTROCARDIAC RIGID ADULT 21FR 25IN 4300S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":147.6,"discounted_cash":36.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR VERSAPORT BLADELESS V2 OPT 12 ONB12STF","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":572.37,"discounted_cash":143.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER RELOAD EGIA30CTAVM ***DISC SEE ECH #025389","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1970.91,"discounted_cash":492.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL DST 60MMX3.5MM TA6035S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2329.14,"discounted_cash":582.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCISSORS LAP DA VINCI XI ENDOWRIST POTTS 8MM 470001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2109.44,"discounted_cash":527.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCISSORS ENDOWRIST DA VINCI XI ROUND TIP 8MM 470007","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1622.25,"discounted_cash":405.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING FOAM MEPILEX SILVER 6 X 6IN 395490","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":203.01,"discounted_cash":50.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DA VINCI SPATULA ENDOWRIST MONO PERM CAUTERY 8MM 470184","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1297.8,"discounted_cash":324.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE PIN 3 X 75MM STERILE 9722908","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1400.8,"discounted_cash":350.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS DAVINCI XI CADIERE 8MM 470049","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE DRIVER DA VINCI XI ENDOWRIST MEGA 8MM 470194","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2379.3,"discounted_cash":594.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCISSORS MONOPOLAR CURVED HOT SHEARS XI ROBOTIC 8MM 470179","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3460.8,"discounted_cash":865.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS BIPOLAR MARYLAND XI 8MM 470172","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":566.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"*USE 036250*NEEDLE DRIVER MEGA SUTURECUT 470309","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEAL DA VINCI XI UNIVERSAL 5-8MM 470361-08","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":194.67,"discounted_cash":48.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD ENDOWRIST STAPLER 45MM GREEN 48445G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS DA VINCI XI TENACULUM 8MM 470207","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2379.3,"discounted_cash":594.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HOOK PERMANENT CAUTERY DA VINCI XI 470183","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1297.8,"discounted_cash":324.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALER VESSEL ENDOWRIST DA VINCI XI 480322","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5360.95,"discounted_cash":1340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS PROGRASP DA VINCI XI 8MM 470093","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":566.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRASPER DA VINCI XI FENESTRATED TIP 470347-UP 8MM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2379.3,"discounted_cash":594.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS DA VINCI XI FEN BIPOLAR 8MM 470205","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":695.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP LIGATING HORIZON SMALL WIDE RED 001201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.97,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE QUICK-CORE BIOPSY 20G 10T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":614.6,"discounted_cash":153.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 1 EXCEL 8-18IN GRN BRD CTX CX30D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":79.83,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE SCALPEL BLUNT BLADE TUBESET 20MM 110-31-1120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5766.85,"discounted_cash":1441.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CAPIO NON-ABSORABLE 36IN M0068332351","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":449.5,"discounted_cash":112.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA FLAT TIP J-SHAPE HYDRODISSECTION DISP 25 GA K20-3170","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":50.47,"discounted_cash":12.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY CATHETER FOLEY SURESTEP SYSTEM 16FR A303316A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.75,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SPREADER AR-19007GS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3862.5,"discounted_cash":965.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PULSE PATIENT REFERENCE ARRAY KIT 5050401","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3296.0,"discounted_cash":824.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GELPOINT PLATFORM ACCESS INSUFFLATION SATBILIZATION BG CNB11","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7883.75,"discounted_cash":1970.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MYOSURE FLUENT TISSUE REMOVAL SYSTEM 50-603XL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8782.95,"discounted_cash":2195.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPIDER 2 SHOULDER STABILZATION KIT 72203833","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":915.36,"discounted_cash":228.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACP BLOOD DRAW KIT SERIES I ABS-10011T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2214.5,"discounted_cash":553.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER TRAY W/HOLDER 16FR 899916","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":81.47,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRASP ENDO FORCEPTS FLEXCYSTO SINGLE USE FG-253SX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":682.89,"discounted_cash":170.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE FIXATION TROCAR BLUNT 0.9X150MM DSDS1009","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":216.3,"discounted_cash":54.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE ARTHROSCOPIC APOLLO RF SMALL JOINT 50D AR-9845","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VERSAJET II HANDPIECE PULSED LAVAGE 45D 14MM 66800041","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6126.8,"discounted_cash":1531.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE TAPE W/CC NEEDLE BLUE WHITE 1.7MM AR-7511","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING HYDROCOLLOID AQUACEL AG 3.5X6IN 422604","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":220.42,"discounted_cash":55.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE TYMPANOPLASTY 2.5MM WIDE 60ï¿½ ANGLE BEVEL DOWN #377200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":140.9,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER DERMATOME SKIN CARRIER 1.5:1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":207.55,"discounted_cash":51.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE PIN LEFT 3D CORRECTION FIXATION 12.5IM-15FP TG12-515L","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13974.51,"discounted_cash":3493.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER DYNAFORCE 2.2MM 7000-0022","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1753.47,"discounted_cash":438.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INSTRUMENT VIRTUGUIDE PIN JOINT SEEKING 7000-JRW4","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5520.25,"discounted_cash":1380.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE HYPODERMIC RIGID DISPOSABLE 21GA 0.5IN 9012M0","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":684.02,"discounted_cash":171.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BIOPSY BONE MARROW ASPIRATION 691.100S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3602.94,"discounted_cash":900.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE CEMENT TROCHANTERIC NAIL AUGMENTATION SYS DISP ABS-1094","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER MOTOBAND CP DYNAFORCE 1500-SPSK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5485.47,"discounted_cash":1371.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PROLENE 2-0 1/2 TAPER 36MM 8853H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":47.28,"discounted_cash":11.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE NICELOOP SZ 5 GREEN SMSL50103","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":699.97,"discounted_cash":174.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIPOLAR HANDPIECE TRIGGER FLEX PROBE DISP 31CM DTF-31","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL LATEX FREE DISP 18GA DFX-N8/1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SUPPORT SLEEVE TUBE 315MM 16-0104","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2317.5,"discounted_cash":579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL DIAMOND DISP 3.7X355MM 16-0202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3656.5,"discounted_cash":914.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE HIGH FREQUENCY BIPOLAR 26176VLD-10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":231.75,"discounted_cash":57.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE CHROMIC GUT 5.0 C-3 12IN 723G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":54.9,"discounted_cash":13.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER DYONICS BONECUTTER PLATINIUM 4.5MM 72202531","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":896.1,"discounted_cash":224.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE KEITH STRAIGHT 2-0 30IN 8623H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.12,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR LAPAROSCOPIC MINI STEP DILATOR W/CANN 7/8MM MS101008","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":967.79,"discounted_cash":241.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER SURGICAL CANN 4.0MM AR-8973-40S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT SHORT 2.5MM AR-7650-35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":412.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA CLEAR TRACK FLEXIBLE SYSTEM 5.5X72MM 72200429","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":255.44,"discounted_cash":63.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE PIN DRILL TIP 2.8X450MM 110008399","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1644.4,"discounted_cash":411.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR OVAL 8 FLUTE 4.0X13 DISP AR-8400OBE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":607.7,"discounted_cash":151.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CUTTER BONE COOLCUT 5X13 DISP AR-8500BC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":679.8,"discounted_cash":169.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"2 FIBERWIRE SUTURE W/TAP NEEDLE 38IN(BLU/WHTE/BLK) AR-7208","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":494.4,"discounted_cash":123.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER MICRON 200 SINGLE USE EMP-FBX200HS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2379.3,"discounted_cash":594.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABS 1.3MM 2 STRAND AR-7501","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":669.5,"discounted_cash":167.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE HI-FI LOW PROFILE KNOT 2 C-2 40IN BRAID H5100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":355.56,"discounted_cash":88.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPLINT NASAL DOYLE OPEN LUMEN 60-203","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL DISTAL LOCK 2MM AR-2669","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1081.5,"discounted_cash":270.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER MICRON 550 SINGLE USE EMP-FBX550HS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2880.09,"discounted_cash":720.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPANDER OPHTHALMIC MALYUGIN 2.0 RING 6.25MM MAL-1001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1459.2,"discounted_cash":364.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TORPEDO SHAVER SJ SMALL HUB 3.5mm AR-9350TD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1040.3,"discounted_cash":260.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR FULL RADIUS BENDABLE 30o P9376","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OPHTH I-KNIFE II 15D STD 3MM DISP 8065921532","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":79.1,"discounted_cash":19.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX KNOT PUSHER SUTURE CUTTER AR-5845","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2266.0,"discounted_cash":566.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL BIT 4.8mm 110008408","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1823.1,"discounted_cash":455.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE THUNDERBEAT OPEN JAW W/GRIP DISP TB-0009OFX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8665.82,"discounted_cash":2166.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE 1.1MM HCS-040-11","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX COOL CUT TORPEDO 4mm x 13cm AR-8400TD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1040.3,"discounted_cash":260.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OSTEOTOME 1.5 INCH FLAT 38mm ARS743201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3378.4,"discounted_cash":844.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE THUNDERBEAT EXTENDED JAW 20CM DISP TB-0920OE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER DYONICS HELICUT BURR 7205727","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":206.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT 2.5MM AR-8933HD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE FIBERTAPE 2MM 17IN BLUE AR-7237-17LN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BATTERY POWER DRIVER 62-50201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2781.62,"discounted_cash":695.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLAMP VASCU-STATT II 45D 75-80GM BULLDOG DISP 1001-533","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":108.25,"discounted_cash":27.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR EGG RESURFACING TOOL 4.0MM DISP 1900-015-040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":667.44,"discounted_cash":166.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR ROUND COOLCUT 8 FLUTE 4.0X13 AR-8400RBE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":607.7,"discounted_cash":151.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA ACCUPORT BONE CEMENT MULTI 8GA 200MM 308.083","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4783.32,"discounted_cash":1195.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN TEMPORARY FIXATION ACP 7786703","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":808.34,"discounted_cash":202.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE RECIP SAW 8X50X1 351-91-03","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSC SAW 10X75X1.19 351-91-04","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR RING ALEXIS SML MED 2.5-8CM DISP HR004","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2523.5,"discounted_cash":630.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW DYNABUNION  7000-40SB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE FIXATION 2.0X4 7000-20K4","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE FIXATION 2.0X6 7000-20K6","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION FLUTE 3.2X150 20-8000-000-10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION FLUTE 3.2X80 20-8000-000-11","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ABLATOR APOLLORF H20 SPIRATING 50 AR-9815","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2049.7,"discounted_cash":512.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA TRIPLEDAM TWIST-IN W/VALVE 8.25MM AR-6530TD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":412.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE MAX BRD #2 MO-6 2PK CM0222N","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":370.8,"discounted_cash":92.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTERSTIM PERCUTANEOUS ELECTRODE 100CM 3560022","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL JUGGERKNOT SHORT SHAFT 2.9MM 110005306","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":842.64,"discounted_cash":210.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INSTRUMENT REVCON 4MM RIK40-S 974-001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER BREAST ROUND MINI 430CC SZM-430","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER DYONICS ELITE INCISOR PLUS LONG CURVE 18CM 4.5MM 72200494","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":784.45,"discounted_cash":196.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACKING NASAL NOVAPAK CHITOSAN CELLULOSE STANDARD CS3600-10","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1843.7,"discounted_cash":460.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAVIGATION GPS V2 ROBOTIC KIT A10012","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5180.75,"discounted_cash":1295.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION COLLAR 3.2MM 521-78-23","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":952.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION THREAD 3MM 521-78-32","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":952.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WAND ELECTROSURGICAL ARIS TURBINATE REDUCTION 72290113","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3399.0,"discounted_cash":849.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL CANNULATED 3.6MM AR-8741-32","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION COLLARLESS 2.6MM 521-78-31","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3811.0,"discounted_cash":952.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VERZERA ROUND FLUTE BUR 3.5MM 22.5 #6261.5357S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3347.5,"discounted_cash":836.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NERVE ABLATION LEVEL 3 PROCEDURE KIT RLV 0055","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":24105.6,"discounted_cash":6026.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN EXTERNAL FIXATION XTRAFIX LARGE 4X35X100MM 00-5204-040-35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1193.05,"discounted_cash":298.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLASMALOOP ELECTRODE LOOP STANDARD 12D 16D WA22702S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4274.09,"discounted_cash":1068.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL CANNULATED SMOOTH 2.7X110MM DRILL-2.7/110C S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INFUSION PHENOM MICRO STRAIGHT TIP FLEXIBLE .021IN 6X15X160CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12010.33,"discounted_cash":3002.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL ACUTRAK 3 MICRO 80-4139","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":659.2,"discounted_cash":164.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRAW TUNNELING TOOL DISP 28CM SC-4252","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE ENDOTRACHEAL KIT DISP 8.0MM 2010480","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2179.27,"discounted_cash":544.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLAMP EXTERNAL FIXATION 1 BAR 33MM 00520001004","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9048.02,"discounted_cash":2262.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN EXTERNAL FIXATION XTRAFIX YELLOW LARGE 5X35X160MM 00520405035","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1310.08,"discounted_cash":327.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TYMPANOPLASTY 60 BEAVER DEGREE BLADE STERILE 377200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":233.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IRRIGATION TUBE SET 05.001.178.01S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1194.8,"discounted_cash":298.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLASMANEEDLE ELECTRODE 12-30D WA22755S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4274.09,"discounted_cash":1068.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PASSER SUTURE FIBERTAPE CERCLAGE AR-7825","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2317.5,"discounted_cash":579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL CONICAL 2.9X13MM AR-300-B101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 2-0 FS-1 27IN VCP443H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 2-0 CP-2 18IN VCP762D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":121.44,"discounted_cash":30.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 2-0 UR-6 27IN VCP602H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.79,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS LIGAPAK 0 54IN VCP287G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.72,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 4-0 SH-1 27IN VCP218H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.7,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEARS SURGICAL HARMONIC CURVE TIP 36CM HAR1136","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 1 CT-1 18IN VCP841D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":95.07,"discounted_cash":23.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 1 CT 18IN VCP753D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":94.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 3-0 FS-2 27IN VCP423H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL PRODISC-C MILL FLAT COUPLING 2MM 03.820.169S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PASSER SUTURE FIBER TAPE CERCLAGE STRAIGHT MEDIUM AR-7821","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2317.5,"discounted_cash":579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PERMA-HAND SILK 2-0 KS BRAID BLACK 30IN 623H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PERMA-HAND SILK 4-0 SH BRAID BLACK 30IN K831H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER INTERNAL ENTACT SEPTAL 601-00100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1951.85,"discounted_cash":487.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OSTEOTOME SURGICAL SQUARE PRECISION 7MM DISP SN24","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSTRUMENT ORTHOPEDIC ACTIVATION TOOL DISPOSABLE S0457-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT SURGICAL GPS HIGH SPEED 3.5MM 6143.2582S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM IRRIGATION SAPS 10 CC 1 ACTION 1 WAY VALVE VACUUM M0067201001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":447.31,"discounted_cash":111.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL TWIST MIDFACE SHAFT 1.35 5X50MM 60-13505","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1689.92,"discounted_cash":422.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BAG TISSUE RETRIEVAL ANCHOR 25MM TRS-TV-25","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2348.4,"discounted_cash":587.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"UROLIFT DELIVERY HANDLE CARTRIDGE KIT UL2-CHK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9685.75,"discounted_cash":2421.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPINAL SYSTEM LX DX-22-500","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":3153.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL CONICAL 2X19.5MM AR-300-B201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NANONEEDLE HIGH FLOW OPERATIVE SURGICAL KIT 125MM AR-3210-0051","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1184.5,"discounted_cash":296.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL TWIST SHAFT 1.6MM 35X115MM 60-16035","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1750.18,"discounted_cash":437.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER IMPLANT HIGH PROJECTION ROUND SMOOTH 440CC SZ10621-440HP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CUTTING VANTAGE ANKLE PSI 3D TIBIA 351-50-21","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12163.5,"discounted_cash":3040.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORUS PCSS LEVELONE 4MM DX-50-405","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":63720.0,"discounted_cash":15930.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT CERCLAGE FX SYSTEM SMALL PASSER AR-7820SB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13064.5,"discounted_cash":3266.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL ORTHOLOC CANNULATED DISPOSABLE 3X60MM 58850030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACK INSTRUMENT DRILL GUIDE SUTURE ANCHOR 4.75MM THN00201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TAP SUTURE ANCHOR 4.75MM THN00239","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4377.5,"discounted_cash":1094.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ATTACHMENT DURAPRO BARREL TAPER GPS 3.5-4.5MM 30X260MM 6262.3131S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6307.0,"discounted_cash":1576.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX PDS PLUS 3-0 SXPP2B419","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.66,"discounted_cash":57.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR NEEDLE NAVPAK PK1011","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4362.05,"discounted_cash":1090.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER MEMORYGEL XTRA MODERATE PLUS PROFILE ROUND 755CC RSZMPX-755S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3296.0,"discounted_cash":824.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER MEMORYGEL ENHANCE SINGLE USE ULTRA HIGH PROFILE 930CC SZUHE930","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5098.5,"discounted_cash":1274.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER MEMORYGEL ENHANCE SINGLE USE ULTRA HIGH PROFILE 1030CC SZUHE1030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5098.5,"discounted_cash":1274.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE PIN PROSTEP MICA ANTISKIVE 0.9MM 57S90005","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":880.54,"discounted_cash":220.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRIVER MICA HEX 2MM 57S02020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GAUGE DEPTH PROSTEP MICA 150MM 57S000DG","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1359.6,"discounted_cash":339.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER MEMORYGEL XTRA MODERATE PLUS PROFILE ROUND 645CC RSZ-MPX-645S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3296.0,"discounted_cash":824.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL MICA CANNULATED 2.2X60MM 57S00022","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2461.7,"discounted_cash":615.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INSTRUMENT REVCON 4MM 974-001 RIK40-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLEEVE PROTECTION FOR RIGID LONG NAIL 8-13MM 03.043.036S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL RAPIDE MULTIPASS UNDYED 5-0 P-3 18IN VR493","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":44.38,"discounted_cash":11.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INSTRUMENT ANCHOR GRYPHON X DISPOSABLE 271077","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6721.46,"discounted_cash":1680.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER DYONICS ELITE PLUS STRAIGHT 3.5MM 72200095","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":566.5,"discounted_cash":141.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SHAVER DYONICS ACROMIOBLASTER STRAIGHT 4MM 72200730","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":411.59,"discounted_cash":102.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT Q-FIX FLEXIBLE DISPOSABLE 1.8MM 72290118","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4655.39,"discounted_cash":1163.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PICK NANO CHONDRAL ARTHROSCOPY 30D 7CM AR-1091CP-70","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":7658.5,"discounted_cash":1914.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER SABRE 2MM 7CM AR-9200SR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":679.8,"discounted_cash":169.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACK INSTRUMENT DARTFIRE EDGE D0025000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2341.91,"discounted_cash":585.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRIVER MICA HEX 2.5MM 57S02025","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL DISPOSABLE 1.8X100MM DRILL-1.8/100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1421.4,"discounted_cash":355.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA ARTHROSCOPIC SHOULDER GREEN 72MM 72200425","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2758.34,"discounted_cash":689.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COUNTERSINK 2.3MM HSINK-2.3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL EPIC CANNULATED QUICK CONNECT 3.1X135MM 1100-3100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER ROUND-MINI 400CC SZM-400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER ROUND-MINI 360CC SZM-360","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER ROUND-DEMI 525CC SZD-525","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER ROUND MINI 310CC SZM-310","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER ROUND MINI 290CC SZM-290","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER ROUND MINI 275CC SZM-275","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT MINI ASPIRATION RECELL GO PREPARATION AVRL0105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STYLET NAVIGATION 2 COIL 23CM 9735428","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5748.38,"discounted_cash":1437.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE QUILL MONOFILMENT PDO 2 VLT 36CMX48MM RA-1065Q","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":171.5,"discounted_cash":42.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE MONODERM QUILL SRS PDO VIOLET 0 36X36CM RA-1067Q","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":164.39,"discounted_cash":41.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE NONABSORB 5-O BLUE 13MM M8720","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3821.09,"discounted_cash":955.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM-X CORUS PCSS POSTERIOR INSTRUMENTATION 5MM DX-50-404","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":29713.5,"discounted_cash":7428.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE PLASMABUTTON 12 D-30 D WA22760S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4272.44,"discounted_cash":1068.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER DYONICS WIDE CUT WINDOW YELLOW 4.5MM 72203521","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":556.72,"discounted_cash":139.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER SURGICAL ANCHORAGE REUSABLE CROSS PLATE 705172","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6072.74,"discounted_cash":1518.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE HI-FI 1 STRAND BRAID BLUE WHITE 1.3MM 39IN HR713WN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":613.47,"discounted_cash":153.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSTEOTOME EXPLANT HEMISPHERE ACETABULAR CUP REMOVAL SYSTEM 54MM 00-7053-054-20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5676.3,"discounted_cash":1419.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT PROCEDURE NUEROLOGY INTRACEPT VB 2 RLV 0045","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18246.6,"discounted_cash":4561.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SIZER ROUND-DEMI 475CC SZD-475","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL CANNULATED 1.6 95MM DRILL-1.6/095C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIXATION KIRSCHNER STAINLESS STEEL 0.8X120MM WIRE-0.8/120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRIVER HEX AO 1.5X70MM DVHX-1.5/070CAO","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER MINI APPLICATOR TRAY SAVI BRACHY GAMMA 6-1 SAVI-06MINIGAMMA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23854.5,"discounted_cash":5963.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRASPER ENDOSCOPIC CAPTURA OPEN WIDER 3 PRONG 2.8FR 115CM G30361","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3218.75,"discounted_cash":804.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW OXFORD 3PACK 11-4845","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9010.0,"discounted_cash":2252.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ELECTROSURGICAL COAGULATE BIPOLAR 24/26FR 27040BL1-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3559.68,"discounted_cash":889.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FLAT EXCHANGE SIBER TITANIUM 3.2X500MM 5040-203","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2317.5,"discounted_cash":579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX PDS 2-0 SH 14CM DYED SXPP2B407","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":286.75,"discounted_cash":71.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WEREWOLF 90 DEG COBLATION WAND DISPOSABLE 72290038","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5831.99,"discounted_cash":1458.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT ORTHOLOC 2.0 X 30MM 58880020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1833.4,"discounted_cash":458.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBING IRRIGATION STRAIGHTSHOT TO XPS 1895522","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":80.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE MONOPOLAR EX LONG CUTTING LOOP 24F 27050GP-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1406.88,"discounted_cash":351.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ENDOSCOPY SHAVER RESECTOR 4MM 375-542-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS BIPOLAR 9IN INSULATED 1.5MM W/CORD DISP 19-5046AU","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3347.5,"discounted_cash":836.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT SPINE ACCESS TLIF 2 MAS 3500017","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":3153.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT MULTIMODALITY NVM5 NEEDLE 8050123","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19669.5,"discounted_cash":4917.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PHOTONGUIDE WIDE/FLAT DISP 104015","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSERTER TIP SPINE DEEP MEDIUM 5MM 03.820.130S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT KYPHON FIRST FRACTURE TRAY II W/INTRODUCER KPX153RB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23987.33,"discounted_cash":5996.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR BLUNT 12MM STD ANCHOR THREADED BPT12STS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1426.55,"discounted_cash":356.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR VERSAPORT BLADELESS V2 OPT 15MM ONB15STF","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1110.65,"discounted_cash":277.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT AO 2.0MMX135MM SCALED 703896","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":437.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAGITTAL 50 X 18 X 97MM 6118-097-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":494.71,"discounted_cash":123.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER CIRCULAR 3.5X28MM DISP BLUE EEA2835","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6228.16,"discounted_cash":1557.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT KYPHO FIRST FRACTURE SURGICAL TAMP KPX203RB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23987.33,"discounted_cash":5996.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER 4.3MMX13CM 4 CUTTER 1884380HRE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2027.86,"discounted_cash":506.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER XPS CRV RAD SINUS 4MMX11CM ROTATING 1884006HRE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2076.48,"discounted_cash":519.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SI-BONE DRILL BIT DISP CANNULATED 7.0MM 400146","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4078.8,"discounted_cash":1019.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BIOCARTILAGE SMALL JOINT ABS-1000-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2523.5,"discounted_cash":630.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DISPOSABLE KIT FOR DX FIBERTAK AR-8990DS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT NEUROMONITORING FOR I-FUSE 400170","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6261.95,"discounted_cash":1565.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL PROFILE COMPRESSION FULL THREAD 5.0MM AR-8750-05","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT XL PROFILE 7.0MM DISP AR-8770-03","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSC SAGITTAL NARROW 18 DEG 5X5 2296-003-412","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.36,"discounted_cash":54.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT CANNULATED LONE 3.2MM AR-8750-09","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE STRATAFIX PDS PLUS 0 45CM VIOL SXPP1B407","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":232.64,"discounted_cash":58.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TIP INSERTER ARTICULAR SURFACE 42529900301","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":602.55,"discounted_cash":150.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT CANNULATED 3.2MM AR-8750-04","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCLARENT SE INFLATION DEVICE #SEID","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":767.87,"discounted_cash":191.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER COUDE FOLEY 16FR 5CC 2 WAY 0170SI16","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":195.39,"discounted_cash":48.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL PIN BUTTON AR-2272","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BIOCARTILAGE LARGE JOINT ABS-1000-L","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2523.5,"discounted_cash":630.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW SAGITTAL 86.5X25X1.32MM 6125-137-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":465.05,"discounted_cash":116.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURG 2.3MM 80MM DRILL-2.3/080","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1174.2,"discounted_cash":293.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE WIRE-1.1/100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT Q-FIX SHOULDER 2.8MM DISP 25-2810","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE BLUNT TROCAR 1.4X150MM DSDS1014","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH VERSAFLEX PH MONITOR ADULT 22CM FGS-9000-19","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1317.37,"discounted_cash":329.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRASPER DA VINCI XI SMALL 8MM 470318","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIPLINE 8 SURGICAL SKIN CLOSURE PS2080","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE EXACT DURASEAL 5ML SYSTEM 206520","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11313.59,"discounted_cash":2828.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW FALCON PRECISION EVOVLE 25X1.27X90MM 6725-127-090","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2805.1,"discounted_cash":701.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VLOC 90 3-0 UD 15CM CV-23 VLOCM1904","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO SHEARS 5MM #176643. 9/14/10 MV do not order per Marsha W.","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1473.83,"discounted_cash":368.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR MATCHSTICK 2.5MM DIAMOND F/MEDIUM ATTACHMENT M-8ND-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1334.88,"discounted_cash":333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR 2MM DIAMOND BALL FOR MEDIUM ATTACHMENT M-2SD-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2482.3,"discounted_cash":620.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 0 36IN CT GS-24 J958H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.6,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO BABCOCK 10MM #174001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1694.87,"discounted_cash":423.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 3-0 27IN KS CS-1 Y523H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VLOC 90 3-0 VIOLET 15CM CV-23 VLOCM0804","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR FALLER STYLET 8888415679","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1562.92,"discounted_cash":390.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COUNTERSINK CANNULATED AO COUPLING 45-3007","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2605.9,"discounted_cash":651.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPINE DECADE PLATE XLIF FIXATION PIN 7141113","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BIOPSY BONE MARROW CONCENTRATE PROC 60ML BMAC2 60-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT PACKAGE SMALL ART-BMC-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12091.42,"discounted_cash":3022.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL PROFILE MICRO COMPRESSION SCREW AR-8737-46","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL STD PROFILE COMPRESSION FT AR-8737-54","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT ACUTRAK 2 LONG 7.5MM 80-0976","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3955.2,"discounted_cash":988.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION SPEED RIMMED 30MM 74013470","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1042.88,"discounted_cash":260.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR ALEXIS O SELF RETAINING WOUND 2.5-6CM C8401","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":666.07,"discounted_cash":166.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OBTURATOR DA VINCI XI BLDLSS OPTICAL LONG 8MM DISP 470360","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":324.45,"discounted_cash":81.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KNIFE CLEARCUT SATIN SLIT SINGLE BEVEL 8065992747","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":190.04,"discounted_cash":47.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT FOR SWIVELOCK DX 3.5 X 13.5MM DISP AR-8979DS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL CANNULATED COMPRESSION STRAIGHT 2.7MM AR-8737-50","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING LONG DIAMOND BALL 4MM DISP L-4D-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1334.88,"discounted_cash":333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL FLUTE BALL 5MM M-5B-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1334.88,"discounted_cash":333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR LONG STRAIGHT FLUTE MATCHSTICK 3MM L-8NS-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1334.88,"discounted_cash":333.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR DISSECTING STANDARD STRAIGHT DIAMOND BALL 3MM S-3SD-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2338.1,"discounted_cash":584.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KWIRE DOUBLE TROCAR 0.86 AR-8737-39KD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL STANDARD STRAIGHT DIAMOND BALL 2MM S-2SD-G1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1379.38,"discounted_cash":344.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX APOLLO RF XL90 ASPIRATING ABLATOR 90D EX LG AR-9821","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1957.0,"discounted_cash":489.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX CANNULA PASSPORT BUTTON AR-6592-12-30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE AR-SCOPE MEASUREMENT 220x60mm AR-4070-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND EXCEL 2 DYED OS-4 30IN X519H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.82,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRATAFIX 2-0 SPIRAL PDS PLUS VIOLET CT-1 SXPP1B411","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":231.24,"discounted_cash":57.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CUTTING VISIONAIRE LEGION ADPT KIT RT SZF8T5 V0200109","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":1351.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NON-ABSORBABLE 10.0 NYLON CUTTING BLACK AA-1824","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.20,"discounted_cash":95.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NON-ABSORBABLE 9.0 NYLON CUT BLACK AA-1825","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.20,"discounted_cash":95.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE 3.7mm 15DEG GREAT WHITE BENDABLE 37GRW-ME-PB","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CUTTING VISIONAIRE ADAPT SZ F6/T5 DISP V0100109","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":1351.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BONE MARROW ASPIRATION 60ML DISP 51422","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17794.75,"discounted_cash":4448.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT CANNULATED SENTINEL 9X229MM S8590","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DELINEATOR ADVINCULA STEEL PLASTIC CUP 3.0CM AD750-KES30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":726.15,"discounted_cash":181.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE DOUBLE END TROCAR TIP SMOOTH 1.1x150mm P99-292-1115","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":49.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"S&N KNEE PIN FIXATION RIMMED SPEED 65mm 74013472","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1042.88,"discounted_cash":260.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE GREAT WHITE MERLIN 30 DEGREE 3.7mm 37GRW-ME-ZZ","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT CANNULATED 9.5X229MM S8595","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE ENDOSCOPY STERLING ULTRACUT 5.5 C9415","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":679.8,"discounted_cash":169.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K WIRE 1.35mm AR-5050-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":422.3,"discounted_cash":105.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BUR STERLING OVAL LARGE HUB 4.0MM H9101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BUR STERLING OVAL LARGE HUB 6.0MM DISP H9102","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DISSECTOR 5x13cm AR-8500DS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":607.7,"discounted_cash":151.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY IRRIGATION 3-WAY 20FR 5CC 0119L20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":71.69,"discounted_cash":17.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DELINEATOR ADVINCULA ULTEM PLASTIC CUP 4.0CM AD750-KE40","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":726.15,"discounted_cash":181.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER PROSYSTEM K-WIRE 3.C x 150mm 703954S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":999.1,"discounted_cash":249.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHROSCOPY T-DRAPE 89x126x130 DYNJP8104","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":141.47,"discounted_cash":35.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"27G ANTEROIR CHAMBER CANNULA 8065-420-120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.54,"discounted_cash":10.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE SCALPEL 25MM BLUNT 1.0X6.4MM 110-31-1125","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5331.22,"discounted_cash":1332.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE 3-0 PS-2 MONOCRYL STRATAFIX PLUS SXMP1B107","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":277.13,"discounted_cash":69.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE 3-0 PS-2 MONOCRYL STRATAFIX PLUS SXMP1B109","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":279.29,"discounted_cash":69.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE UNDYED FS SPIRAL MONOCRYL SZ 3-0 30X30CM SXMP2B412","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":247.30,"discounted_cash":61.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"3-0 RB-1 STRATAFIX SUTURE 12\" UNDYED MONO SXMP1B424","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":270.85,"discounted_cash":67.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE UNDYED FS-2 SPIRAL MONOCRYL SZ 4-0 30X30CM SXMP2B409","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":251.53,"discounted_cash":62.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE VIVAER ARC 5GM STYLUS DISP CAT500","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17907.38,"discounted_cash":4476.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SONOPLEX II FACET S21 Gx100mm NEEDLE 001287-77","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":172.53,"discounted_cash":43.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SONOPLEX II FACET S22 Gx50mm 001287-74","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":157.08,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR STRAIGHT 20mm DIA 3.1mm AR-300-B202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"1-0 CTX STRAFIX SUTURE 12 DYED SXPP1A445","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":277.48,"discounted_cash":69.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE NERVE STIMULATOR PULSE MONOPOLAR DISP 50110101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX PDS 2-0 CT-1 36CM DYED SXPP2B412","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":230.51,"discounted_cash":57.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX PDS 1 MO-4 36CM DYED SXPP2B400","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":231.44,"discounted_cash":57.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND EXCEL 4X30IN V-37 GREEN MX69GA","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":118.76,"discounted_cash":29.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADES STRAIGHT STERILE 35MM DISPOSABLE ASSI.CBS35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":216.3,"discounted_cash":54.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM MINI GELPOINT WOUND RETRACTOR DISP CNGL3","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"T-TUBE GROMMET 1.27mm LUMEN VT-0403-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":233.5,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STRATAFIX 2-0 MONOCRYL PLUS CT-2 SXMP1B415","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":278.51,"discounted_cash":69.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX LASSO QUICKPASS 90 DEG CURVE AR-6068-90","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":412.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT PERCANTANEOUS INSERTION FOR SUTURE ANCHOR 3MM AR-1938PK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3656.5,"discounted_cash":914.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE NERVE STIMULATOR PULSE CLIP ACTIVATOR DISP 50110201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3068.27,"discounted_cash":767.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT MIOM ELECTRODE PULSE NEEDLE DISP 50120104","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12614.0,"discounted_cash":3153.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DELINEATOR ADVINCULA ULTEM PLASTIC CUP 3.5CM AD750-KE35","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":726.18,"discounted_cash":181.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DELINEATOR ADVINCULA ULTEM PLASTIC CUP 3.0CM AD750-KE30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":726.15,"discounted_cash":181.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE AQUIRE PULMONARY 22GA FINE NEEDLE BIOPSY M00552350","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3656.5,"discounted_cash":914.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PORT ACCESS BLADELESS OPTICAL TIP 5X120 DISP IAS5-120LP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":793.1,"discounted_cash":198.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PORT ACCESS WITH BLADELESS OPTICAL TIP 12X100 IAS12-100LPI","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":814.73,"discounted_cash":203.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR LONE STAR AMC DISPOSABLE 32.5x18.3cm 3304G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":556.2,"discounted_cash":139.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"24FR 30CC RIBBED BALLOON 3 WAY WIDE LUMENT 1857SI24","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":154.81,"discounted_cash":38.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER BLACK THICK TISSUE H4.2mm GST45T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1272.87,"discounted_cash":318.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL CANNULATED AO 2.0x120mm P99-110-2112","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1468.78,"discounted_cash":367.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HOOK SILS ARTICULATING W/MONOPOLAR CUT/COAG XL SILSHOOK46","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1957.0,"discounted_cash":489.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL CANNULATED AO 21.7x120mm P99-110-1712","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1468.78,"discounted_cash":367.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER GREEN THICK TISSUE H4.1mm GST45G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1272.87,"discounted_cash":318.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LAPIPLASTY SAW BLADE STRYKER 40 x 11mm SM-4011","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE MONOPOLAR ANGLED CUTTING LOOP 22FR 27054G-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1080.16,"discounted_cash":270.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN SPINE WILTROM 117MM 75045","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW EXTENSION 75038","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER PRECISION RECIP BLADE 27 x 64mm 5100037233","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":476.79,"discounted_cash":119.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE SINGLE ENDED TROCAR TIP 0.9 x 150mm P99-192-0915","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":49.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MR8 TAPER 3MM 21CM MR8-7TA11","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1372.68,"discounted_cash":343.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT PREP PLUG BRUSH SPONGE SUCTION LF 121010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5360.95,"discounted_cash":1340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE INJECTION INJETAK FLEXABLE DIS199","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":715.85,"discounted_cash":178.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SMR TURBINATE REDUCTION COBLATOR WAND EICA6895-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3263.86,"discounted_cash":815.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN SPINE WILTROM 171mm 75048","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CUTTING LOOP YELLOW 0.35 ELECTRODE 46782435","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":871.9,"discounted_cash":217.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE LOOP OD.35mm 24/26FR 27040GP1-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3557.64,"discounted_cash":889.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLICATOR DUPLOTIP W/SNAP LOCK 5MMX32CM 0601138","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":540.54,"discounted_cash":135.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NON-RIMMED SPEED PIN 65mm 74013480","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1042.88,"discounted_cash":260.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRATAFIX MONO+ KNOTLSS TISSUE CNTRL DEVICE 2-0 SXMP1B417","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":231.25,"discounted_cash":57.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WAVERWRITER PATIENT TRAIL KIT SC-6500-62","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE TAPE TIGERLOOP WITH NDL WHITE/BLACK AR-7534T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":180.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DUPLOSPRAY MIS APPLICATOR 5x40mm 0600030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":890.33,"discounted_cash":222.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT ACF 4.0 X 14MM 14-521014","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":968.2,"discounted_cash":242.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL PLUS 3-0 FS-1 27IN VCP442H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE POS VIL MONO l OB GYN 36IN CT #Z359T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.01,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS VIL MONO 2-0 OB GYN 36IN CT #Z357H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.29,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND GRN BR O ORTHO 3DIN OS-4 #X517H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":4.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND GRN BR O CAROlO 36IN SHSH #X524H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":32.14,"discounted_cash":8.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 8-0 OPHTH 12IN TG175-8 #1716G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":84.46,"discounted_cash":21.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOOP ELECTRODE 5MM BALL E1564","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":105.06,"discounted_cash":26.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE THREADED TIP TROCAR NS 1.6MM 829016006","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":229.48,"discounted_cash":57.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOOP ELECTRODE 10X10MM \"T\" E1559","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":106.91,"discounted_cash":26.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER TRAY FOLEY 16FR 5CC W/2000ML BAG 6946","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":25.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KNIFE OPHTHALMIC SLIT 2.75MM ANGLED 8065992761","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":113.09,"discounted_cash":28.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSTRUMENT SUCTION POOLE W/REMOVABLE SHEATH #35040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER PASSER MALLEABLE 55CM 82-1516","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":989.62,"discounted_cash":247.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1066.05,"discounted_cash":266.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT ENDOSCOPE CARPAL TUNNEL RELEASE DISPOSABLE #4116","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1755.22,"discounted_cash":438.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA J-SHAPE 25GA #8065-4412-20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":81.89,"discounted_cash":20.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CYSTOTOME IRRIGAT REVRS CUT DEEP SET 27G DISP#8065-4266-20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":60.46,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOADING UNIT ENDO STITCH POLYSRB O 48IN ES- 9 #170056","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":442.08,"discounted_cash":110.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 5-0 18IN P-2 1658G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":46.97,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND GRN BR O CLOSURE 3DIN CT-2 #X412H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UNDYD BR O ORTH 3-l8INCR OS-4 #J749T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":56.14,"discounted_cash":14.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL VIL BR 1 3-18 OS-4 #VCP708","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":60.25,"discounted_cash":15.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"*DO NOT*COATED VICRYL VIL BR 5-0 OPHTH 8IN S-14S14 #J591G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":132.25,"discounted_cash":33.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL VIL BR 5-0 OPHTH 18 S-14S14 #J571G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":109.18,"discounted_cash":27.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL VIL BR 7-0 OPHTH 18 TG160-8 #J576G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":111.24,"discounted_cash":27.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL VIL BR 2-0 18IN SH #J775D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":86.95,"discounted_cash":21.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL VIL BR 6-0 OPHTH 18IN S-29 #J555G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":109.9,"discounted_cash":27.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL VIL BR 1 CLOSURE 27IN CT-2 #J335H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.98,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 3-0 LIGAPAK 54IN #J285G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.48,"discounted_cash":4.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 4-0 G.I.27IN SH-1 #J218H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL VIL BR 3-0 G.I.8-27IN C/R SH ETVCP784D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":87.55,"discounted_cash":21.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL RAPIDE UND BR 3-0 PLASTIC 27IN SH #VR416","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.81,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL RAPIDE 4-0 UROLOGICAL 27 RB1 #VR214","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.73,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GUT PL 4-0 CUTICULAR 18IN SC-l #1824H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.28,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PO COATED VICRYL UND BR 1 CLOS 8-18IN SGL STRN #J841D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":87.96,"discounted_cash":21.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GUT CHR 4-0 PLASTIC 18IN PS-S #1653G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.63,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GUT CHR 5-0 PLASTIC 18IN PS-4 #1642G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK BLK BR 4-0 CARDIO 3DIN RB-l #K871H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK BLK BR O G.I. CARDIO 3DIN SH #K834H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9.37,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 4-0 SUTUPAK 12-18IN SS #J109T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":68.6,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 1 SUTUPAK 12-18IN #J913G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":63.76,"discounted_cash":15.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 3-0 SUTUPAK 12-18 #VCP110G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36.05,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL PLUS 4-0 18IN PS-4 #VCP507","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":44.91,"discounted_cash":11.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND GRN BR 5 RETENTION 3DIN LRLR + #B499T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.12,"discounted_cash":7.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR ENDOSCOPY STERLING VORTEX HOODED 4.5MM H9131","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BARD CATHETER FOLEY SILICONE 22FR 5CC 165822","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.02,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL UNDYED 8 INCH DBL ARM TG140-8 J547G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":118.66,"discounted_cash":29.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN SILICONE FLAT 10MM FULL PERFORATION STRL #0070440","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.11,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON CLEAR MONO 5-O PLASTIC 18 P- 3 #690G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.22,"discounted_cash":7.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 4-0 CUTICULAR 3D FSL #1670H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IRRIGATOR SUCTION SOLO SIMPULSE W/TRIGGR LCK STRL #0067570","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":658.07,"discounted_cash":164.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBING LIPOSUCTION BYRON HIVAC 8 FOOT STERILE B5558","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":236.9,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 BLUE 24INCH BV-1 X2 8805H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":97.05,"discounted_cash":24.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE DYNAMIC STIMULATION CLIP 2012022","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3068.27,"discounted_cash":767.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KYPHON BONE BIOPSY DEVICE SZ3 F05A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":948.12,"discounted_cash":237.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRACTOR DISPOSABLE IRIS MALYUGIN RING 7.0MM MAL-0002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1502.05,"discounted_cash":375.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT K-WIRE 0.9X150MM DSDS-1009","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX CANNULA PASSPORT BUTTON 8MMX3CM AR-6592-08-30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRASPER ALLIGATOR MINI LAP DISPOSABLE 255-000-001","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"*DO NOT USE*LOOPS VESSEL MEDI-LOOP 2/PK WHITE DYNJVL13","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.60,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE ENDOSCOPY GATOR MENISCUS CUTTER 3.5MM C9264","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW OSCILLATING FINE 5.5X12X0.4 STERILE #5023-160","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":149.87,"discounted_cash":37.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AEROSOL INTRA-PLEURAL STERILE TALC POWDER 4 GRAM #1680","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1382.26,"discounted_cash":345.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE UNITOME OPTIUM 15 DEGREE #374891","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":132.76,"discounted_cash":33.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX TAPE FIBER SUTURE TAPERED END 2MM #AR-7237","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1081.5,"discounted_cash":270.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR ARTHROSCOPY SPHERCL HIGH SPEED BURR 4.5MM #H9111","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE POLYBLEND BLUE/WHT 36.6MM NOL 11.9MM #AR-7201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE INJECTION 27GX 1 1/2 W/24 LEADWIRE ATTACH #91079","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE MAYO 1/2 CIRCLE TAPER POINT 0.050IN 216707","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.32,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER KNEE SCREW HEADED MIS QUAD-SPARING 33MM 00598304033","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":741.6,"discounted_cash":185.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER KNEE SCREW HEADED MIS QUAD-SPARING 48MM 00598304048","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":180.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 7-0 18INCH P-1  #1696G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":29.25,"discounted_cash":7.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ARTHREX FIBERSTICK 2 W/2 FIBERWIRE 50IN AR-7209","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM SCROTUM RETRACTOR DEEP SKIN DISPOSABLE #72403867","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4454.24,"discounted_cash":1113.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSTRUMENT YANKAUER OPEN TIP WO/ VENT #C0034970DU","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":120.2,"discounted_cash":30.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOADING UNIT GREEN 75MM FOR TCT75/T4T75 LNEAR CUT #TRT75","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":560.84,"discounted_cash":140.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Kii OPTICAL ACCESS SYSTEM THREADED 12X100 C0R29","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":508.61,"discounted_cash":127.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK BLK BR 2-0 12-30 #A305H*DO NOT USE SEE 002053","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTUREMONO 2-0 CLOSURE 30 CT-1 #8423H*DO NOT USE SEE 002104","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.79,"discounted_cash":5.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE BL MONO 4-0 PLASTIC PS-2 l2/BX #8682G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":37.29,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE BL MONO 6-0 PLASTIC 18IN PC-3 #8636G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.44,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE BL MONO 2-0 CAROlO 36IN SHSH #8523H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.72,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LASER FIBER SLIMLINE 200  840-840","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2279.49,"discounted_cash":569.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LASER FIBER SLIMLINE 365  840-842","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":804.84,"discounted_cash":201.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER SLIMLINE 550 MICRON   M0068408430","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":946.88,"discounted_cash":236.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LASER FIBER SLIMLINE 1000   840-844","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1876.15,"discounted_cash":469.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY BRUSH SET 3.2 FR #040310","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1037.62,"discounted_cash":259.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORD GYRUS ACMI ENDOSCOPIC CONNECTOR 10FT BUG BEE 5142708","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":115.88,"discounted_cash":28.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"S CURVE DILATOR SET #073701-CD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2636.18,"discounted_cash":659.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH URETHRAL HEMATURIA ROUND TIP  22FR 30CC 3 WAY #2551H22","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":159.65,"discounted_cash":39.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NCIRCLE NITINOL TIPLSS STONE EXTRACTR G18778 NTSE-022115-UDH","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2995.24,"discounted_cash":748.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSERTER TIP FOR LG AND LGDEEP 5MM HEIGHT03.820.133S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORECEP PIRANHA URTEROSCOPIC BIOPSY 3FR 505-160","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2997.4,"discounted_cash":749.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY COUDE CARSON 16FR #0168L16","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":71.89,"discounted_cash":17.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 12FR 5CC 2WAY COUDE BARDEX LUBRICATH CARSON","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":71.89,"discounted_cash":17.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ENDOSCOPY SERFAS PROBE 90-S 279-351-100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE CAUTERY INSULATED COATED 6 INCH LONG E1455-6","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":33.04,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE MAXCESS FIXATION SHIMS 3200028","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3862.5,"discounted_cash":965.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT W/DEPTH MARK 1.5 X 96MM   #310.507","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1384.42,"discounted_cash":346.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ECHO-TIP 19 EUS NEEDLE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2430.8,"discounted_cash":607.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE FERGUSON #4 #1842-4DC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.27,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"*DO NOT USE*DRAIN PENROSE 1/2 X 18 #0918030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10.92,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 22FR 30CC LATEX","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":20.6,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE KEITH #5 #213405","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":58.4,"discounted_cash":14.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER K-WIRE 1.2 X 100MM   45-30015","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX BB TAKS (FIXATION TACK)  #AR-13226","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE WEL SUCTION DISPOSABLE FULL FLOW ANTI-CLOG STERILE 5091","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":75.19,"discounted_cash":18.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRIL BIT 3.2 X 130MM  310. 310.32","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":873.65,"discounted_cash":218.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE THREADED 0.035IN  0.9MM  2620-39","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":159.65,"discounted_cash":39.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOTTLE TRIGGER SPRAY 16OZ STERILE    D32-410","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":59.53,"discounted_cash":14.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN SUCTION ROUND 15FR 23CM PERFORATED 75CM L 0070220","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":42.75,"discounted_cash":10.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"***DO NOT USE*** NEEDLE SPINAL YALE 18GA X3 1/2IN PINK","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUARD PIN KIRSCHNER WIRE .062IN GREEN #1601-062","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUARD PIN KIRSCHNER WIRE .045IN WHITE #1601-045","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUARD PIN KIRSCHNER WIRE .035IN BLUE #1601-035","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.1,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE KIRSCHNER STYLE 1.062IN DIA 6IN L STERILE #1600-662","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.58,"discounted_cash":10.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE KIRSCHNER STYLE I.045IN DIA 6IN L STER #1600-645","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.58,"discounted_cash":10.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT RETRACTOR RING W/O STAYS STERILE DISP #3307G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":597.4,"discounted_cash":149.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE KIRSCHNER STYLE I.035IN DIA 6IN L STER #1600-635","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.58,"discounted_cash":10.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE KIRSCHNER STYLE 1.045IN DIA 4IN L STERILE #1600-445","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.58,"discounted_cash":10.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TAPE COTTON UMBILICAL 1/8IN X 30IN #31-410","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8.86,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE KIRSCHNER STANDARD .062IN DIA 4IN L STERILE #1600-462","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.58,"discounted_cash":10.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CHOLANGIOGRAPHY W/RETENT CONE 6F 33CM L #C1002","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN J-P CHANNEL ROUND FULL FLU19FR   1/4IN TROCAR  072231","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.49,"discounted_cash":33.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 10-0 OPHTH 12IN TG140-8 #7718G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":94.55,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GUT CHR 4-0 OPHTH 12IN M-lM-1 #744G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":53.05,"discounted_cash":13.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GUT CHR 4-0 OPHTH 18IN S-2S-2 #1798G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":127.41,"discounted_cash":31.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE GUT CHR 6-0 PLASTIC 18IN PS-4 #1641G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":46.14,"discounted_cash":11.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE ENDOSCOPY STERLING GREAT WHITE 4.2MM  #9299A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE ELECTRO LAPAROSCOPIC ABC FLEX HANDSWITCH 10FT 160656","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1241.97,"discounted_cash":310.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PASSER CATHETER SHORT 36 CM #82-1515","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":906.61,"discounted_cash":226.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 5-0 PLASTIC 18IN PS-3 #1668H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.03,"discounted_cash":6.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 3-0 URL.27IN RB-1 #J215H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.01,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 4-0 URL.27IN RB-1 VCP214H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":14.21,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK BLK BR 2-0 GI NEURO 8-18IN COMPARTMENT #C012D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":60.26,"discounted_cash":15.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE BL MONO 3-0 PLASTIC 18IN PS-2 #8687H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":36.26,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE BL MONO 4-0 PLASTIC 18IN PS-2 #8682H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":38.42,"discounted_cash":9.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 5-0 PLAST.18IN PS-2 36/BX #1666H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.03,"discounted_cash":6.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON BLK MONO 4-0 PLAST.18IN P-3 36/BX #699H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 1 36IN CT #J959H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13.7,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL 3-0 8-18\" CRSH TRAY #VCP864D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":95.65,"discounted_cash":23.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR O CLOSUR 8-18 CR TRAY #J840D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":88.68,"discounted_cash":22.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE 2-0 OB-GYN 8-18 CR TRAY #J726D*DO NOT USE SEE 001870","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":102.38,"discounted_cash":25.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE COATED VICRYL UND BR 5-0 PLASTIC 18IN P-3 #J493G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":34.4,"discounted_cash":8.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND EXCEL 2-0 36IN GREEN SH-1 X763H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":31.62,"discounted_cash":7.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND EXCEL NON-ABSORB OS-4 GREEN 30IN X519H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.84,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER CONE MTP 20MM GEN 2 455 SS  58890220","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2502.9,"discounted_cash":625.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER CUP MTP 20MM GEN 2 455 SS 58890120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2502.9,"discounted_cash":625.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SHAVER DYONICS BONECUTTER PLATINUM 3.5MM DISPOSABLE 72205108","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1677.87,"discounted_cash":419.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PASSER SUTURE FIRSTPASS MINI PRELOAD DISPOSABLE 72290128","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":10474.13,"discounted_cash":2618.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP IRRIGATION MAKO 111331","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1114.77,"discounted_cash":278.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUTTLE SUTURE ACCU-PASS 1 MONOFILAMENT 72201361","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE SAW PRECISION FALCON CARTRIDGE OSCILLATE TIP 25X1.37X105MM 6725-137-105","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2805.1,"discounted_cash":701.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE NVM5 MULTIMODALITY NEEDLE DISP KIT 8050123","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19669.5,"discounted_cash":4917.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PERMA-HAND SILK 6-0 BRAID BLACK 2 ARM 18IN 706G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":53.14,"discounted_cash":13.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDOSCOPIC PLANTAR FASCIOTOMY DISP KIT 3100-D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":8036.92,"discounted_cash":2009.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BRONCHOSCOPE FLEXIBLE EXALT MODEL B SLIM 3.8 M00542711","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3079.7,"discounted_cash":769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE ROD ORTHO MULTILOC TROCAR TIP 2.5X230MM 03.019.026","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":182.20,"discounted_cash":45.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INSTRUMENT BIOPSY MAX-CORE ANGLE 18GA 22MM 17.8X20CM MC1820","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":290.46,"discounted_cash":72.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SHAVER DYONICS NOTCHBLASTERS STRAIGHT 4MM 72200726","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE PDS II MONOFILAMENT UNDYED 3-0 FS-1 27IN PDP442H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":29.97,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TIP INSERTER PRODISC-C DEEP LARGE 5MM 03.820.133S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REAMER SURGICAL CANN LONG 3.2MM AR-8973-32LS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GUIDE NOSE BALL 3.0 X 900MM 0101-900S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL HOLLOW OPEN MEDULLARY MULTILOC 10MM 03.019.003","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2600.85,"discounted_cash":650.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE COAGULATING 27FR POINTED BROWN #27050K","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1010.22,"discounted_cash":252.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH DYNAMIC STIMULATION 2010036","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":180.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GORE-TEX SUTURE CV-4 24 TTC-13 (X2) 5K02A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":383.68,"discounted_cash":95.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ENDOSCOPY SERFAS PROBE 90-S MAX 4MM 279-401-100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL 3 FLUTE QUICK CONNECT CALIBRATE 3.8X270MM 03.019.016","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1942.48,"discounted_cash":485.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON OPILUME DRUG COATED 30FR 50MM 1110-10050B","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":25947.0,"discounted_cash":6486.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON OPILUME DRUG COATED 24FR 30MM 1147-08030","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRANSPERINEAL NEEDLE GUIDE KIT 590-03001-00","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":407.67,"discounted_cash":101.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POLARIS NON-STICK BIPOLAR FORCEPS 1.5MM 7IN 19-2226PL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":13289.75,"discounted_cash":3322.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POLARIS NON-STICK BIPOLAR FORCEPS 1.5MM 9IN 19-2246PL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15767.5,"discounted_cash":3941.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL A-O STYLE 4.0 X 165MM S0210-200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POSITIONER TARGETER PIN NITINOL STERILE 2.8MM AR-5400-400NS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOOL DISSECTING MR8 BALL 6MM 14CM MR8-14BA60","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2021.99,"discounted_cash":505.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR SURGICAL STRAIGHT 3.1X20MM AR-300-B202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OPTICAL FIBER FOR THE TFL DRIVE LASER FSI365","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3296.0,"discounted_cash":824.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE GORE-TEX CV-6 TTC-13 30IN 6M04A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":384.5,"discounted_cash":96.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE PERMA-HAND SILK 2-0 BRAID BLACK 30IN K873H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OPTICAL THULIUM LASER FIBER 200UM FSX200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":749.84,"discounted_cash":187.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OPTICAL THULIUM LASER FIBER 365UM FSX365","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":749.84,"discounted_cash":187.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT 1.7MM AR-18800-49","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE 1.1X120MM WIRE1.1/120","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OPTICAL THULIUM LASER FIBER 550UM FSX550","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":958.93,"discounted_cash":239.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER HOLMIUM LIGHTGUIDE 600 UM HLFD0600C","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3481.4,"discounted_cash":870.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORD BIPOLAR DUAL 12FT US349SP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":69.42,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR DIALYSIS ARGYLE TI PERITONEAL 2 PART LUER ADAPTER 8888415604","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1222.92,"discounted_cash":305.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR CORTICAL WEDGE 3.1 X 13MM 58RW3113","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5415.01,"discounted_cash":1353.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER SOLTIVE THULIUM 550 UM TFL-FBX550S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLEEVE IRRIGATION PM2 58PM2SLV","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5216.79,"discounted_cash":1304.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OSTEOTOME HOOKED STERILE SN25","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER OPTICAL DRIVE TFL 550UM FSI550","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4212.7,"discounted_cash":1053.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTRACTOR STONE NITINOL 1.7FR 115CM STERILE DISPOSABLE G48294","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3079.08,"discounted_cash":769.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE NERVE STIMULATOR STANDARD INCREMENT PRASS TIP 8225825X","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1922.08,"discounted_cash":480.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 4-0 BLACK 18IN 8 STRAND C014D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":59.95,"discounted_cash":14.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CALIBRATED DRILL 4.0 X 280MM S0219-100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBING IRRIGATION DRILLSAW HIGHSPEED 200 SET OEM04364100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":334.75,"discounted_cash":83.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE SUTURELOOP HI-FI STRAIGHT NEEDLE 20IN 60MM HL200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":607.7,"discounted_cash":151.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OPTICAL FIBER FOR TFL DRIVE LASER 1000UM FSI000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5955.61,"discounted_cash":1488.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VISTASEAL APPLICATOR LAPAROSCOPIC 45CM VSTL45","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":895.93,"discounted_cash":223.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"T-TUBE GROMMET 1.27MM LUMEN VT-0403-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":256.47,"discounted_cash":64.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENT RETRIEVER SNARE NITINOL UNIDEX 2.4FR 115CM G46191","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1236.72,"discounted_cash":309.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSTEOTOME EXPLANT HEMISPHERE TRUNCATE 50MM 00705305010","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5676.3,"discounted_cash":1419.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD REAMING BALL TIP EXTENSION 2.5X650MM 351.709S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1175.23,"discounted_cash":293.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE STRATAFIX MONOCRYL PLUS 4-0 PS-2 SPIRAL 12IN SXMP1B117","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.53,"discounted_cash":44.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OBTURATOR W/TROCAR LOPRO AIRSEAL 8X120MM IAS8-120LP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":789.7,"discounted_cash":197.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LASER FIBER HOLMIUM AGILITI SU 365UM 8000230","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2111.5,"discounted_cash":527.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR SURGICAL LONG 8-13MM 03.043.012S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1332.72,"discounted_cash":333.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE FIXATION SINGLE END TROCAR TIP SMOOTH 1.1X100MM P99-192-1110","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":259.56,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SURGICAL PULSE NONFIDUCIAL KIT 10CM 5050410","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":1236.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ABSORBABLE VICRYL 3-0 BRAID COATED UNDYED 27IN J588H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":41.1,"discounted_cash":10.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE MONOPOLAR ROLLER COAGULATION 12D 30D 46782201","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":867.57,"discounted_cash":216.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OPTICAL THULIUM LASER FIBER 200UM FSV200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5270.85,"discounted_cash":1317.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCORPION NEEDLE HD AR-13999HDN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL LONG 2MM AR-18800-11","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO STITCH POLYSORB 2-0 48IN ES-9 VIOLET 170053","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":442.08,"discounted_cash":110.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE IRRIGATION HYDROCLEANSE SINUS SUCTION 1960100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1214.16,"discounted_cash":303.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE MIS SHARP BRGR 501168","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSTEOTOME EXPLANT SMALL 58MM 00705305810","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5676.3,"discounted_cash":1419.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL SURGICAL SMALL SHORT AO QUICK CONNECT 3.5MM 71175027","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2707.56,"discounted_cash":676.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRESSING AQUACEL AG 3.5X10IN 422605","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":276.04,"discounted_cash":69.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER LASER 550U DISP 8000231","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2111.5,"discounted_cash":527.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE DX KNOTLESS FIBERTAK DISP KIT AR-8991DS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC IMAGE GUIDED PATIENT TRACKER","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2086.68,"discounted_cash":521.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACC LNCS ADTX- ADULT SPO2 ADHESIVE SENSOR-MASIMO CORP","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":47.48,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER K-WIRE 0.8X100MM 45-20015","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL ASNIS MICRO CANN AO 3.0X2.1MM 45-30005","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2775.85,"discounted_cash":693.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPEED RELEASE GUIDED RELEASE INSTRUMENT SN20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE RETROBULBAR (ATKINSON) 23GA 1.5 #581638","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":44.19,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDO STITCH POLYSORB 3-0 48 ES-9 VIOLET #170071","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":429.2,"discounted_cash":107.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ENDO STITCH SURGIDAC 0 #173024","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":442.08,"discounted_cash":110.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRITOME TRIPLE-EDGE RELEASE SINGLE USE INSTRUMENT SN21","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIT DRILL FLUTE QUICK COUPLING 4.2X145MM 03.010.104S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2024.16,"discounted_cash":506.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC DEVICE INFLATION LACTICATH CATH BALLOON QL 4015 40CC 96313","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DRILL BIT CALIBRATED 2.5MM AR-8943-13","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUT PRODISC-C RETAINER SCREW SYSTEM 03.820.110-CS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SPINAL SHORT BEVEL 22GAX8IN 18394","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.06,"discounted_cash":24.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLES ETHICON ECHELON 45 GRAY RELOAD ECR45M","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1114.05,"discounted_cash":278.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX BIO-TENODESIS DISPOSABLE KIT AR-1676DS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GELPOINT ADVANCE ACCESS KIT W/RETRACTOR AND SEALS CNGL2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLEEVE ETHICON XCEL STABILITY 11MM CB11LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":123.29,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX CANNULA PASSPORT BUTTON 8MMX4CM AR-6592-08-40","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":329.6,"discounted_cash":82.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE QUILL POLYDIOXANONE 2 VIOLET 36CM T11 X2  RA-1065Q","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":174.69,"discounted_cash":43.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SEALER AQUAMANTYS MALLEABLE BIPOLAR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4459.9,"discounted_cash":1114.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 6-0 18\" BLACK P-3 #1639","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":27.4,"discounted_cash":6.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE QUILL POLYDIOXANONE 0 VIOLET 36CM T9 X2 RA-1067Q","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":167.38,"discounted_cash":41.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE QUILL MONODERM 2-0 CLEAR YA-1024Q","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":174.69,"discounted_cash":43.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OSTEOMED K-WIRE 0.045X6IN 316-0006","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":216.3,"discounted_cash":54.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE I-PASS III NEEDLE BEVEL TIP 2010029","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL CANNULATED 2.0MM DSDS-0020","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"S&N DRILL FLEXIBLE 25MM 71362925","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2552.13,"discounted_cash":638.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN WOUND ROUND SILICONE 7FR W/ADAPTOR #DYNJWE1320","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":56.96,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 24IN BV DBL ARM M8610","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":391.19,"discounted_cash":97.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 3-0 36IN GREEN DBL ARM SH X522","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":31.72,"discounted_cash":7.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELOAD STAPLER LINEAR CUTTER 45-2.5MM WHITE TR45W","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":985.49,"discounted_cash":246.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE LOCKING AND BIOPSY CAP SYSTEM  M00545260","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":92.7,"discounted_cash":23.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STYKER BURR BARREL 4.0MM 6FLUTE 375-941-000","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":381.1,"discounted_cash":95.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR VERSASTEP REPOSABLE 5mm #VSR101005","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3040.46,"discounted_cash":760.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBER DORNIER HOLMIUM LASER SINGLE USE 270 MICRON #DUR270D","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":771.47,"discounted_cash":192.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 3/0 18 IN UNDYED PS-2","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":7.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 12FR SILICONE STERILE BARDEX VLV #165812","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.02,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE MONOCRYL 3 0 36IN UNDYED 90CM #Y944H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE 1/2 TAPER MAYO CATGUT .56 WIRE DIAM 1.96 IN NDI LENTG 216705","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":63.76,"discounted_cash":15.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORD ACMI ELITE STERILE DISPOSABLE #DAC","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":148.32,"discounted_cash":37.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA TWIST-IN 8.25MM X 9CM AR-6540","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE ENDOTRACHEAL NIM EMG 6MM 8229306","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3318.66,"discounted_cash":829.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER COUNCIL TIP 22FR 5CC 0196L22  BARD","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":105.88,"discounted_cash":26.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE BEAVER 6600 EYE 60 DEG LAMELLAR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":339.8,"discounted_cash":84.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLOSURE SYSTEM CARTER-THOMASON II  #CTI-1015P","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1695.38,"discounted_cash":423.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 3-0 36IN GRN RB-1 #X558H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":32.14,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 2-0 12-30IN GRN TIES X305","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHIBOND 2-0 EXCEL 10-30IN BRD DA SH 10X82","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":137.19,"discounted_cash":34.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPLINT BIVALVE LARGE THIN 890918","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":168.50,"discounted_cash":42.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BIOPSY MAGNUM 18GA X 25CM DISP MN1825","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":234.14,"discounted_cash":58.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 8-0 VIOLET 12IN TG140-6 J974G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":143.38,"discounted_cash":35.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER BURR OVAL LONG 4.0MM 5300-20-901","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":210.64,"discounted_cash":52.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT MEDICAL DRILL BIT 2.8MM 58850028","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER K-WIRE SMOOTH 1.4 X 100MM 45-80200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":247.2,"discounted_cash":61.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT PIN FIXATION TEMPORARY 1.4MM 58820006","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":700.4,"discounted_cash":175.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET TUBE GUIBOR ROUND CURVE 17.7 X 33CM 8590350","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1522.63,"discounted_cash":380.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"S&N KNEE PIN FIXATION RIMMED SPEED 45MM 74013471","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1042.88,"discounted_cash":260.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PUREGRAFT 850/PURE SYSTEM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5139.7,"discounted_cash":1284.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS 5-0 27IN VIOLET RB-1 Z303H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":19.88,"discounted_cash":4.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 0 BLUE 18INCH CT-1 C821G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":117.94,"discounted_cash":29.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ELECTRODE ARTHROWAND AMBIENT SUPER TURBOVAC 90D ASHA4250-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4693.71,"discounted_cash":1173.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE VISCOELASTIC VISCOAT OPH DISPERSIVE .50ML 8065183905","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":400.16,"discounted_cash":100.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BARD EAGLE INFLATION DEVICE 20CC 325130","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":606.57,"discounted_cash":151.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NUVASIVE K WIRE NITINOL BEVEL/BLUNT 8801069","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEPUY MITEK NEEDLE EXPRESS SEW III 214141","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2404.02,"discounted_cash":601.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX KIT TRANSTIBIAL ACL AR-1898S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1493.5,"discounted_cash":373.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE RIGID SIDEKICK 21GAX14.6IN INJ COAPTITE M0068903040","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":505.11,"discounted_cash":126.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER K-WIRE 3.2 X 300MM 70-2462","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":597.4,"discounted_cash":149.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GYRUS ACMI BLADE ANGLED MYRINGOTOMY 70130780","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":658.69,"discounted_cash":164.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER RASP LG TEAR CROSS CUT 14 X 7MM 5100-037-114","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":836.46,"discounted_cash":209.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"S&N ENDO PLASMA WAND PROCISE XP EICA8872-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3028.2,"discounted_cash":757.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SUTURE NONABSORBABLE FIBERWIRE #2 38\"  BLUE AR-7211","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":103.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET IRRIGATION GRAVITY FLOW Y-TYPE 81IN","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":91.88,"discounted_cash":22.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER BURR MILLING 00-5927-050-00","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1297.8,"discounted_cash":324.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET PROCEDURE GENESYS HTA PROCERVA 58021 M006580210","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":11262.5,"discounted_cash":2815.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE BIOPSY BIPLANE FOR 8818 UA1322-S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":165.93,"discounted_cash":41.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT 3 FLUTED 3.2 X 145MM 03.010.103","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1572.19,"discounted_cash":393.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SI-BONE STEINMANN FIXATION PIN BLUNT 3.2MM 500374","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":103.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DI-BONE IFUSE FIXATION PIN 3.2MM 500373","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":103.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT KWIRE 1.6 X 150MM 44112008","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":216.3,"discounted_cash":54.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLICATOR COVIDIEN EXTENDED TIP 8CM 205108-01","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2592.72,"discounted_cash":648.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOUND VAC GRANUFOAM DRESSING KIT SENSATRAC LG M8275053/5","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":446.4,"discounted_cash":111.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TOURNIQUET CUFF DISP 18IN LUER LOC 5921018236","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":212.39,"discounted_cash":53.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 4-0 30IN BLK BRD SA SH #K831H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT 4-0 30 V-20 G121H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENSEAL TISSUE SEALER G2 CURVED ARTICULATING 35CM NSLG2C35A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4704.42,"discounted_cash":1176.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRASPER TIP RAPTOR SUPER ATRAU SINGLE USE 3632","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":525.3,"discounted_cash":131.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 1 6-30IN BLK TIES A307H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9.68,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE SILK 4-0 18IN BLK BRD FS-2 683G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SI-BONE IFUSE EXCHANGE PIN 3.2MM 500375","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":206.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULATED COUNTERSINK 2.8MM AO COUPLING SU 45-20007","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2798.51,"discounted_cash":699.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR EXCEL BLADELESS OPTIVIEW 12MM 2B12LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":176.13,"discounted_cash":44.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CUTTER LINEAR ARTICULATING 45MM ATS45","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1956.76,"discounted_cash":489.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER ECHELON FLEX POWERED ARTICULATING 45MM PCE45A","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3253.77,"discounted_cash":813.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VERSITOMI SMA FLEXIBLE GUIDE PIN 0234108200","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2906.15,"discounted_cash":726.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR LAP ENDOPATH XCEL 8MM BLADELESS OPTICAL TIP B8LT","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE FIXATION SECURESTRAP 5MM ABSORBABLE MESH STRAP12","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3829.64,"discounted_cash":957.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE TUBING VITREOUS FRONT CENTURION 23GA 8065752134","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1890.36,"discounted_cash":472.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER K-WIRE 2.0 THR 702459","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":813.7,"discounted_cash":203.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOSTON SCIENTIFIC HEX WRENCH SC-4275","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER DRILL 2.7MM 702449","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3172.4,"discounted_cash":793.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VLOC 180 0 6IN GREEN GS21 NEEDLE VLOCL0306","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":228.76,"discounted_cash":57.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"S N ACCU-PASS SUTURE SHUTTLE 70 DEGREE 72200419","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1112.4,"discounted_cash":278.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KNIFE OPHTH CLEARCUT SIDEPORT DUAL BEVEL 1.0MM 8065921540","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FORCEPS BIPOLAR 7IN 1.5MM TIP DISP 19-2026AU","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER TOURNIQUET CUFF 18IN RED DUAL PORT DISP 5921-018-235","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":213.52,"discounted_cash":53.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER RASP SMALL TEAR CROSS CUT 11 X 5MM 5100-37-113","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":836.46,"discounted_cash":209.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE MILL BONESHARK STERILE SINGLE DISP BS101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE FIXATION ABSORBATACK 30 TACK ABSTACK30X","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":5266.35,"discounted_cash":1316.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES DRILL BIT QUICK COUPLING 2.5 X 230MM 315.92","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1732.25,"discounted_cash":433.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT ASNIS AO CANNULATED 2.0X1.7MM 45-20005","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":669.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE VICRYL 3-0 UNDYED BRD 27IN FSL J588H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":17.61,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE FIBERWIRE NONABSORBABLE 38IN BLUE AR-7202","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ETHILON 6-0 18IN CLEAR P-1 689G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":28.53,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PROLENE 6-0 24IN VISIBLACK BV-1 8305H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":105.99,"discounted_cash":26.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACUMED DRILL ACUTRAK 2 PROFILE 4.7MM SCREW 80-0945","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3955.2,"discounted_cash":988.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACUMED DRILL ACUTRAK 2 LONG 4.7MM SCREW 80-0946","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3955.2,"discounted_cash":988.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE INCREMENTING WITH STANDARD PRASS TIP 8225825X","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1922.05,"discounted_cash":480.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR MEDIUM 3MM 6 FLUTES ROUND HEAD 5300-010-509","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":132.56,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER COVIDIEN ABSORBATACK 5MM 30 TACKS ABSTACK30","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3946.76,"discounted_cash":986.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET STEINMANN PIN THREADED 1/8 X 2.5 406669","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2214.5,"discounted_cash":553.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ENDO DASH ERCP DASH-T 0.25IN 5.5FR G25514","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPLINT NASAL DENVER ALUMINUM SERIES 1500 SMALL 10150005KS","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":530.55,"discounted_cash":132.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPLINT NASAL DENVER ALUMINUM SERIES 1500 LARGE 10150005KL","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":530.55,"discounted_cash":132.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSC SAGITTAL LONG NARROW 4.1 X 21.5 X .3 2296-003-414","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.36,"discounted_cash":54.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SUTURE BRAIDED POLYBLEND AR-7250","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BLADE OSC SAGITTAL THIN NARROW 3.9 X .3  X19.8 2296-003-206","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":218.36,"discounted_cash":54.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE PDS PLUS 4-0 VIOLET 27IN SH #PDP315H","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":22.76,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOSTON SCIENTIFIC CABLE 2X8 OR SC-4108","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TIP OPHTH ANGLE POLYMER IRRIGATION ASPIRATION 8065751511","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":98.67,"discounted_cash":24.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT DRILL BIT 2.5 X 60MM 58850025","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1163.9,"discounted_cash":290.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE CHROMIC GUT URO 0 27IN UND MONO BP-1 47T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":79.31,"discounted_cash":19.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE STAINLESS STEEL 0 SS26G","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":45.32,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUCTION FRAZIER 8FR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":21.42,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAUTERY TIP EXTENDER E-Z CLEAN 6INCH 0014","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":43.47,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 22FR 5CC LATEX STERILE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":15.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 20FR 30CC 3WAY LATEX 0167L20","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":72.1,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER COUNCIL TIP 18FR 5CC 0196L18","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":160.89,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POSISEP NASAL PACK 0.5IN X 1.5IN 9210564","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE NONABSORBABLE FIBERWIRE 2-0 HALF CIRCLE BLUE AR-7242","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACP BLOOD DRAW KIT SERIES II ABS-10012","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR CERVICAL OS FINDER 1176","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":40.69,"discounted_cash":10.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPINE MILLING BIT 2.0MM FLAT COUPLING 03.820.169S","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3879.5,"discounted_cash":969.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES GUIDE WIRE DRILL TIP 2.5 X 300MM 03.120.026","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":632.83,"discounted_cash":158.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PADDING CAST WEBRIL II COTTON 3IN X 4YD CRIMPED STERILE 2754","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT TEMPORARY FIXATION PIN 1.4MM LG 58820024","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":700.4,"discounted_cash":175.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX ANKLE DISTRACTOR STRAP AR-1712","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOUND VAC DRESSING LARGE GRANU-FOAM 26 X 15 X 3.3CM","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":488.74,"discounted_cash":122.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRAIN 1/8 PVC WOUND #215-18","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":201.37,"discounted_cash":50.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE 20GA INTRODUCER SITE-RITE","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACUMED DRILL MICRO-ACUTRAK 2 LONG 80-0100","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":3048.8,"discounted_cash":762.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX TIGHT ROPE DRILL PIN 4MM AR-1595T","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR MEDIUM 4MM 8 FLUTES ROUND HEAD 5300-010-511","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":132.56,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRILL BIT SPINE ACF 4.0 X 12MM 14-521012","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":968.2,"discounted_cash":242.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"POWERLOC MAX INFUSION ALLPOINTS NEEDLE SET 20GA 75IN AN142075","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOPSY BIOPINCE ULTRA W/COAX 18GA 15X11.8CM 360-1580-03","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":545.9,"discounted_cash":136.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX DRILL BIT CANNULATED 2.0MM AR-8737-34","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOSENTRY TRACT SEALANT BIOSPY SYSTEM H787768022019S1","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":15767.5,"discounted_cash":3941.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR MEDIUM 2.3MM 3 FLUTES SIDE CUTTING 1608-002-101","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":340.11,"discounted_cash":85.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE INTRODUCER UNI BIOPSY COAXIAL 13.5GX6 PP1356","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":114.54,"discounted_cash":28.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENTERAL FEEDING TUBE 12FR","code_information":[{"code":"27200000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":91.16,"discounted_cash":22.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HEMOSTAT ABSORBABLE PURASTAT 3ML 621-062","code_information":[{"code":"27201052","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1052","type":"HCPCS"}],"standard_charges":[{"gross_charge":6081.75,"discounted_cash":1520.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR COALITION MIS 15MM 1136.2015","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5292.48,"discounted_cash":1323.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION LCP SS LOCK VA STARDRIVE BUTTRESS T8 1.8X18MM 02.210.088","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1770.88,"discounted_cash":442.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADHESIVE SURGICAL BIO-GLUE 5ml #BG3515-5-US","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7148.53,"discounted_cash":1787.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE DX FIBERTAK 26.2MM AR-8991","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5360.95,"discounted_cash":1340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION LCP SS LOCK VA STARDRIVE BUTTRESS T8 1.8X10MM 02.210.080","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1770.88,"discounted_cash":442.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WASHER ASNIS III TITANIUM LARGE  619904","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.1,"discounted_cash":121.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE PIN 3.2 X 330MM S0100-000","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1442.0,"discounted_cash":360.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE GRASPER TROCAR 14MM PMITCSG","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.8,"discounted_cash":23.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE PIN ORTHOPEDIC TROCHANTERIC 3.2X381MM S0100-381","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN UNIVERS II SET AR-9207S","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLER SKIN PROXIMATE ROTATE HEAD 360D 3.9X5.7MM PRR35","code_information":[{"code":"27201713","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.81,"discounted_cash":240.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM ATHERECTOMY HAWKONE DIRECTIONAL SMALL 6FR H1-S","code_information":[{"code":"27201714","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":26599.86,"discounted_cash":6649.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE SEED IMPLANT BRACHY PKG/5 917205","code_information":[{"code":"27201715","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1715","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.30,"discounted_cash":109.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE BRACHYTHERAPY APPLICATOR 18GA 20CM CPPS-MN-1820","code_information":[{"code":"27201715","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1715","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.5,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ATHERECTOMY JETSTREAM XC 7FX135 2.1-3MM .014 - BAYER","code_information":[{"code":"27201724","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":23377.41,"discounted_cash":5844.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ATHERECTOMY ROTAPRO OS 2.0 1.50MM H749394671500","code_information":[{"code":"27201724","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":16983.85,"discounted_cash":4245.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ATHERECTOMY ROTAPRO OS 2.0 1.25MM H749394671250","code_information":[{"code":"27201724","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":16983.85,"discounted_cash":4245.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 4.0 X 8","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 4.0 X 12","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 4.0 X 15","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 4.0 X 20","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 4.5 X 15","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 5.0 X 8","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 5.0 X 12","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 5.0 X 15","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON ENROUTE ENFLATE 4.0X25MM SR-4025-BC","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3491.7,"discounted_cash":872.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 5.5 X 8","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 6.0 X 8","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOLVERINE CB MR US 10mm x 3.50mm H74939401103500","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6847.6,"discounted_cash":1711.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WOLVERINE CB MR US 10mm x 3.00mm H74939401103000","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6847.6,"discounted_cash":1711.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.75 X 12","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.5 X 20","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ATLAS GOLD 14MMX4CMX80CM 7F .035 - BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.5 X 12","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ULTRAVERSE 6X40MM U357564","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ULTRAVERSE 4X40MM U357544","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 8MM 8X75CM CQF7588","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 9MM 4X75CM CQF7594","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 9MM 8X75CM CQF7598","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 10MM 4X75CM CQF75104","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 10MM 8X75CM CQF75108","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 12MM 4X75CM CQF75124","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 5MM 4X75CM CQF7554","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 6MM 4X75CM CQF7564","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 6MM 8X75CM CQF7568","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 7MM 4X75CM CQF7574","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.5 X 15","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 7MM 8X75CM CQF7578","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPHERAL DORADO 10MMX4CMX80CM .035-BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPHERAL DORADO  7MMX40CMX80CM .035-BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DILATATION ATLAS GOLD BALLOON 14X60 ATG120146","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH DORADO 5MMX4CMX80CM 5F .035 - BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ATLAS GOLD 12MMX4CMX80CM 7F .035 - BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 2.75 X 12","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.0 X 8","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.0 X 12","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.07,"discounted_cash":249.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.0 X 15","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.0 X 20","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.25 X 12","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 3.5 X 8","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CONQUEST 8MM 4X75CM CQF7584","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 4MMX40MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH DORADO 9MMX4CMX80CM .035 6F BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 6MMX40MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ANGIOSCULPT EVO 2.0X10MM 139CM 2200-2010-B","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7027.8,"discounted_cash":1756.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ANGIOSCULPT EVO 3.0X10MM 139CM 2200-3010-B","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7027.8,"discounted_cash":1756.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ENROUTE ENFLATE NYLON TRANSCAROTID SHORT 5X25X75CM SR-5025-BC","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3491.7,"discounted_cash":872.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION INPACT PACLITAXEL UREA 6FR 80CM 6X80MM IAV06008008P","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":13830.35,"discounted_cash":3457.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION TRUE 13FR 26MM 4.5X110CM 0264513","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION MINI TREK II PEBAX HYDROCOAT 2 LUMEN 145CM 2X8MM 1012403-08A","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.73,"discounted_cash":286.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION INPACT PACLITAXEL UREA 7FR 80CM 7X40MM IAV07004008P","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":13830.35,"discounted_cash":3457.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION INPACT PACLITAXEL UREA 6FR 40CM 6X40MM IAV06004004P","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":13830.35,"discounted_cash":3457.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION EMERGE PUSH MONORAIL PTCA 144CM 1.2X12MM H7493919012120","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION EMERGE PUSH MONORAIL PTCA 144CM 1.2X8MM H7493919008120","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION NC EMERGE MONORAIL PTCA 143CM 4.5X8MM H7493926708450","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION VALVULOPLASTY 23MMX4.5CM 0234512","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION MINI TREK II PEBAX OTW 1.50X8MM 1012402-08A","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1174.2,"discounted_cash":293.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DILATION BALLOON EMERGE 1.2MMX12MM H7493918912120","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DORADO 7F 10MMX8CMX80CM DR80108","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON ENROUTE ENFLATE 4.0X35MM SR-4035-BC","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3491.7,"discounted_cash":872.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON ENROUTE ENFLATE 5.5X35MM SR-5535-BC","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3491.7,"discounted_cash":872.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON MINI TREK II 1.2MMX8MM 1012401-08Z","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON ENROUTE ENFLATE NYLON SHORT 75CM 6X25MM SR-6025-BC","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3491.7,"discounted_cash":872.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION SAPPHIRE II PRO 1.25X10MM 212-103-5UU","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.4,"discounted_cash":175.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER LITHOTRIPSY JAVELINE PERIPHERAL IVL JVNPIVLF","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":39339.0,"discounted_cash":9834.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON ARMADA JETCOAT 2X80MM 150CM 1013463-080","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATION ARMADA JETCOAT OTW 2X120MM150CM 1013463-120","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATION ARMADA JETCOAT OTW 3X120MM 150CM 1013465-120","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATION ARMADA JETCOAT OTW 3X200MM 150CM 1013465-200","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION TAKERU RX LOW ENTRY PROFILE PTCA 1.5X6MM DC-RY1506UA1","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2451.4,"discounted_cash":612.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPHERAL DORADO 8MMX4CMX80CM .035-BARD DR8084","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SHOCKWAVE E8 IVL 5.0X80 MM E8IVL050080","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":34107.75,"discounted_cash":8526.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ANGIOSCULPT EVO HYDROPHILIC 3X15MM 2200-3015-B","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7027.8,"discounted_cash":1756.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER VIATRAC 14 PLUS 5X20X135","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.4,"discounted_cash":411.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 7MMX40MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 7MMX40MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BARD DORADO PTA BALLOON 6MMX10CM  DR135610","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DORADO BALLOON DILATATION 7FR DR135710","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH DORADO 8MMX8CMX80CM .035 6F BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ULTRAVERSE 5X40MM U357554","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPH. STERLING MONORAIL 4.5MMX40MMX135CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.2,"discounted_cash":576.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL DORADO 5MMX4CMX135CM-BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL DORADO 7MMX4CMX120CM-BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL STERLING MONORAIL 4MMX20MMX135CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.2,"discounted_cash":576.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL STERLING MONORAIL 5MMX20MMX80CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.2,"discounted_cash":576.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL STERLING MONORAIL 5X40MM 135CM-BSCI H74939032504010","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.2,"discounted_cash":576.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER VIATRAC 14 PLUS 6X20X135","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.4,"discounted_cash":411.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL STERLING MONORAIL 5MMX60MMX135CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.2,"discounted_cash":576.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL STERLING MONORAIL 6MMX20MMX80CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.2,"discounted_cash":576.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL STERLING MONORAIL 6MMX60MMX135CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.2,"discounted_cash":576.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL STERLING MONORAIL 8MMX40MMX135CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.2,"discounted_cash":576.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL VIATRAC RX .014 4X20X135-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.4,"discounted_cash":411.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL VIATRAC RX .014 5.5X30X135-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.4,"discounted_cash":411.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL VIATRAC RX .014 5X30X135-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.4,"discounted_cash":411.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PFO SIZING BALLOON 24MMX70CM-AMPLATZER","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4089.1,"discounted_cash":1022.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPHERAL DORADO 6MMX4CMX80CM .035-BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SHOCKWAVE E8 4.0X80MM E8IVL040080","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":39339.0,"discounted_cash":9834.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON PERIPHERAL STERLING MONORAIL 6MMX20MMX135CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2307.2,"discounted_cash":576.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ULTRAVERSE 5FR 75CM 4X100MM U3575415","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION EV3 EVERCROSS OTW PTA 8X80MM 135CM AB35W08080135","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION EV3 EVERCROSS OTW PTA 6X40MM 135CM AB35W06040135","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 6MMX120MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 7MMX60MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 7MMX120MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 8MMX20MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 8MMX40MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 10MMX40MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 14MMX40MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ATLAS GOLD 16MMX4CMX80CM 8F .035 - BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 1.5MMX8MMX144CM PUSH-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 1.5MMX12MMX144CM PUSH-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 1.5MMX15MMX144CM PUSH-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 2MMX8MMX144CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 2MMX12MMX144CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 2MMX15MMX144CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION EV3 EVERCROSS OTW PTA 5X80MM 135CM AB35W05080135","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 2.5MMX8MMX144CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 2.5MMX12MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON CATHETER EMERGE MR 15MM X 2.5MM H7493918915250","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 2.5MMX20MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 3MMX8MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 6MMX60MMX135CM .035 B2060-060","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 3MMX12MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 6MMX40MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 5MMX120MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 4MMX120MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2546.16,"discounted_cash":636.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 3MMX120MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2546.16,"discounted_cash":636.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 3MMX40MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 2.5MMX200MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2546.16,"discounted_cash":636.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 2.5MMX120MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2546.16,"discounted_cash":636.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 2.5MMX40MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 2MMX200MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2546.16,"discounted_cash":636.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH DORADO 8MM X 10CM X 135CM 0.35 6F - BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 4MMX200MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2546.16,"discounted_cash":636.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA INOUE 28MMX70CM MITRAL VALVE SET-TORAY","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":22599.0,"discounted_cash":5649.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 35 LL 5MMX150MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.08,"discounted_cash":318.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 35 LL 5MMX200MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.08,"discounted_cash":318.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 35 LL 6MMX150MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.08,"discounted_cash":318.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 5MMX40MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 7MMX80MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 8MMX20MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 8MMX40MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 10MMX20MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 10MMX40MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 12MMX40MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 14MMX40MMX80CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 4MMX40MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 5MMX40MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 6MMX20MMX135CM .035-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 3MMX15MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 2MMX20MMX144CM-BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 3MMX20MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 6MMX80MMX80CM","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 4MMX40MMX80CM","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 18 4X40X150 OTW","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 18 4X150X150 OTW","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 18 5X40X150 OTW","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 18 5X100X150 OTW","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 18 5X150X150 OTW","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 18 6X100X150 OTW","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 18 6X200X150 OTW","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA ATLAS GOLD 18X4X80 7F","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 2.25 X 15","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 2.5 X 8","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 2.5 X 15","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1021.04,"discounted_cash":255.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 2.5 X 20","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION LUTONIX 035 PACLITAXEL 5X60MM LX3575560V","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":14830.46,"discounted_cash":3707.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ULTRAVERSE 035 GEOALIGN 75CM 5X150MM U3575515","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION ULTRAVERSE 035 GEOALIGN 75CM 6X150MM U3575615","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 3MMX200MMX150CM OTW .014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2546.16,"discounted_cash":636.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 10MMX20MMX135CM","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 8MMX60MMX80CM","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA 18 6X40X150 OTW","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH LUTONIX DCB 5MMX100MMX130CM .035 5F -BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":14830.46,"discounted_cash":3707.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 3.5MMX12MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 3.5MMX15MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 3.5MMX20MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO EMERGE RX 4MMX20MMX144CM - BSCI","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 9MMX40MMX80CM","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 5X60MM 135CM .035IN B2050-060","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 6MMX80MMX135CM .035 - ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 8MMX80MMX80CM","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 1.5MMX40MMX150CM OTW.014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 2MMX40MMX150CM OTW.014-ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA14 4MMX80MMX150CM OTW.014 - ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.53,"discounted_cash":450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMERGE NC BALLOON 2.5 X 12","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA TRUE 24MMX4.5CMX110CM 12F VALVULOPLASTY -BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA TRUE 22MMX4.5CMX110CM 12F VALVULOPLASTY -BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA TRUE 20MMX4.5CMX110CM 11F VALVULOPLASTY -BARD","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANGIOSCULPT SCORING 2.5X10MM 137CM","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7027.8,"discounted_cash":1756.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO ANGIOSCULPT RX 3.5MMX10MMX137CM SCORING -ANGIOSCORE","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7027.8,"discounted_cash":1756.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA PERIPH ARMADA35 10MMX60MMX80CM - ABBOTT","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.86,"discounted_cash":251.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA CORO ANGIOSCULPT RX 3.5MMX15MMX137CM SCORING -ANGIOSCORE 2200-3515-B","code_information":[{"code":"27201725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7027.8,"discounted_cash":1756.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRE WG W/BILIARY 18-20MM/240CM/5.5 F/G","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.82,"discounted_cash":513.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRE WG W/BILIARY 15-18MM/240CM/5.5 F/G","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.82,"discounted_cash":513.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRE WG W/BILIARY 12-15MM/240CM/5.5 F/G M00558690","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.82,"discounted_cash":513.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRE WG W/BILIARY 10-12MM/240CM/5.5 F/G M00558680","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.82,"discounted_cash":513.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOSTON SCIENTIFIC ENCORE INFLATION DEVICE M0067101140","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.25,"discounted_cash":82.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR 2CMX6,7,8MM ELATION PULMONARY BALLOON P6L20","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE INFLATION BALLOON DILATION 60CC MAJ-1740","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON CRE 18-20","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.6,"discounted_cash":442.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR 2CMX8,9,10MM ELATION PULMONARY BALLOON P8L20","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR 2CMX10,11,12MM ELATION PULMONARY BALLOON P10L20","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR 2CMX12,13.5,15MM ELATION PULMONARY BALLOON P12L20","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OLYMPUS RADIAL BALLOON  MAJ-233","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.85,"discounted_cash":54.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SHOCKWAVE  E8 IVL 150CM 6.0X80MM E8IVL060080","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":39339.0,"discounted_cash":9834.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON CRE 10-11-12MM","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.6,"discounted_cash":442.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON DILATION CRE 6-8CM","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.82,"discounted_cash":513.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON CRE 15-16.5-18MM","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.6,"discounted_cash":442.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION HURRICANE 180X4X4 M00545900","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2358.7,"discounted_cash":589.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"15X16.5X18MM 5.5CM DILATOR CRE PULMONARY BALLOON #M00550310","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2987.0,"discounted_cash":746.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON CRE WIRE GUIDED DIALATOR 6-7-8 M00558660","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.82,"discounted_cash":513.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON DILATOR CRE 8-10MM 8CM","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.6,"discounted_cash":442.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON CERV DILATATION W/RIPENING STYLET 18FR 40X80 G19891","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.13,"discounted_cash":172.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON CERVICAL RIPENING 18FR 40CM 80ML G48149","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":498.62,"discounted_cash":124.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON CRE 12-13.5-15MM","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.6,"discounted_cash":442.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRE WG W/BILIARY 8-10MM/240CM/5.5 F/G M00558670","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2053.82,"discounted_cash":513.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON NEPHROSTOMY ULTRAXX 10MM 15CM G30365","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":3314.03,"discounted_cash":828.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON4MMX4CM10CC # 887404UROFORCE EAGLE INFLAT DEVICE KIT #998404","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.4,"discounted_cash":741.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE INFLATION EAGLE 10CC #325110","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.24,"discounted_cash":112.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRE RX BILIARY BALLOON DILATATION CATH12-13.5-15mm M00558890","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":695.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"X-FORCE 24FR x 15cm URETHRAL BALLOON DILATOR 995081","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2967.95,"discounted_cash":741.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"X-FORCE 30FR x 4cm BALLOON DILATOR BLADDER NECK 998004","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2966.4,"discounted_cash":741.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE EUSTACHIAN BALLOON CATHETER 6X16 EU061655","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":15103.82,"discounted_cash":3775.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON NEPHROSTOMY X-FORCE N30 26FR 8MM 996081","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH OPILUME DRUG COATED OPTILUME 24 KIT 5X75CM OPTBDL7009B","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":31387.5,"discounted_cash":7846.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON DILATATION RELIEVA SPIN PLUS SYSTEM 6X16MM RSP0616MFS","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":17569.5,"discounted_cash":4392.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON DILATATION CRE RX 10X11X12MM M00558930","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2781.0,"discounted_cash":695.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE URETHRAL DRUG COATED BALLOON CATHETER 24FR 50MM 75CM 1110-08050B","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR 3CMX10,11,12MM ELATION PULMONARY BALLOON P10L30","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BALLOON NEPHROSTOMY ULTRAXX PTFE 15CM G57617","code_information":[{"code":"27201726","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":3594.7,"discounted_cash":898.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DISTENTION BALLOON OVAL-PREPERITONEAL W/INFLATION BULB #OMS-PDBS2","code_information":[{"code":"27201727","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1727","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.93,"discounted_cash":633.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CENTESIS ONE-STEP 6FR 12CM OSC-6F-12PLT","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.58,"discounted_cash":105.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE CATHETER YUEH 5F 19G X 10CM G09490","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.6,"discounted_cash":48.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":195.60,"discounted_cash":48.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY 14FR 29CM SURGICAL PNEUMOTHORAX WAYNE 14FR 29CM G56537","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":3039.43,"discounted_cash":759.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTERNAL DRAINAGE SENTINEL CEREBRAL PROTECT SYS CMS15-10C-US","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":33480.0,"discounted_cash":8370.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DRAINAGE BIO-MEDICUS LIFE SUPPORT 15FR 11.5CM LS96010-015","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":3935.63,"discounted_cash":983.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DRAINAGE BIO-MEDICUS LIFE SUPPORT ARTERY 13FR 11CM LS96010-013","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":3976.83,"discounted_cash":994.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"THERMOCHEM HYPOTHERMIA OUTFLOW LASSO TUBING 3/8\" FLW-0010","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.4,"discounted_cash":200.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER NEPHROSTOMY SKATER 10FR 25CM 756610025","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.5,"discounted_cash":167.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DRAINAGE BIOGLIDE MARK LENGTH 35CM 27705","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1641.41,"discounted_cash":410.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 2 WAY LATEX FREE 16FR 30CC 176816","code_information":[{"code":"27201729","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.55,"discounted_cash":9.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER RESPONSE CSL DECAPOLAR CURVE 65CM 6FR 2-8-2MM","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":4068.5,"discounted_cash":1017.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER OCTARAY SPACE F CURVE DISP 3-3-3-3-3MM D160906","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":19602.54,"discounted_cash":4900.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP CATHETER RESPONSE CRD QUADRIPOLAR 5F X120CM 2-5MM","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.74,"discounted_cash":93.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP CATHETERRESPONSE CRD QUADRIPOLAR 5F X120CM 5MM","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.92,"discounted_cash":93.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP SUPREME QUAD JSN CATH. 5FX120CM 5-5-5MM SPACING","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.77,"discounted_cash":93.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER HD GRID MAPPING BI-DIRECTIONAL D-AVHD-DF16","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":18832.5,"discounted_cash":4708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP CATH WEBSTER CS BI DIRECT AUTO ID 7F EZ STEER F-J CURVE","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1825.74,"discounted_cash":456.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER TEMP BALLOON BIPOLAR 5FX110CM ELECTRODE-BARD","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1330.76,"discounted_cash":332.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SPACE D CURVE STEERABLE 4 ELECTRODE AUTO ID 6FR 2-5-2MM 92CM D6DR252CT","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.62,"discounted_cash":265.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER MARINR MCXL 7FR","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":5333.92,"discounted_cash":1333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER OCTARAY SPACE F CURVE DISP 2-2-2-2-2MM D160904","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":19602.54,"discounted_cash":4900.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER MAPPING ADVISOR HIGH DENSITY GRID X SENSOR ENABLED 8FR 110CM D-AVHDX-DF16","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":20925.0,"discounted_cash":5231.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER PACEL SPACE RIGHT HEART CURVE FLOW DIRECT 1X110CM 5FR 401764","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":843.57,"discounted_cash":210.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER AUTO ID DODECAPOLAR F CURVE 6FR CSF10 PIN D135304","code_information":[{"code":"27201730","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":3244.5,"discounted_cash":811.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER MAPPING OPTRELL DF CURVE 36 ELECTRODE D142901","code_information":[{"code":"27201731","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":19602.54,"discounted_cash":4900.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER MAPPING OPTRELL FJ CURVE 36 ELECTRODES D142902","code_information":[{"code":"27201731","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":19602.54,"discounted_cash":4900.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER LIVEWIRE STEERABLE DIAGNOSTIC EP X-LRG CURL 6F 115CM 2-5-2-5-2-5-2-5-2MM 401915","code_information":[{"code":"27201731","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.98,"discounted_cash":314.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP ABLATION EZ STEER NAVISTAR 4MM F-J CURVE BIDRECT","code_information":[{"code":"27201732","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":18849.24,"discounted_cash":4712.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP CATHETER STEERABLE DUODECA SUPER LG CURL 95CM7F 2-10-2MM","code_information":[{"code":"27201732","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":2717.49,"discounted_cash":679.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ABLATION QDOT MICRO FJ CURVE D139504","code_information":[{"code":"27201732","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":34107.75,"discounted_cash":8526.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ABLATION QDOT MICRO DF CURVE D139505","code_information":[{"code":"27201732","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":34107.75,"discounted_cash":8526.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ABLATION DECANAV F CURVE 10 POLE 7FR 115CM 2MM 2-8-2MM R7F282CT","code_information":[{"code":"27201732","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":9739.81,"discounted_cash":2434.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRYOSPRAY ABLATION KIT FOR TRUFREEZE SYSTEM","code_information":[{"code":"27201733","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":15271.95,"discounted_cash":3817.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CRYOABLATION FREEZOR XTRA MED 3-55MM 217F3","code_information":[{"code":"27201733","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ABLATION FARAWAVE PULSED FIELD 31MM M004PF41M401","code_information":[{"code":"27201733","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":59826.0,"discounted_cash":14956.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ELECTROPHYSIOLOGY VARIPULSE BIDIRECTIONAL 8.5FR D141201","code_information":[{"code":"27201733","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":42826.92,"discounted_cash":10706.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ABLATION BRX RFA EXPRESS 64082","code_information":[{"code":"27201733","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":24674.76,"discounted_cash":6168.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"URETEROSCOPE FLEXIBLE DIGITAL REVERSE 7FR PU3033A","code_information":[{"code":"27201747","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1747","type":"HCPCS"}],"standard_charges":[{"gross_charge":11692.28,"discounted_cash":2923.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ACCUCATH ACE 20GA 2.25IN AC1202250","code_information":[{"code":"27201751","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.95,"discounted_cash":105.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CVC CATH KIT 3 LUMEN 7FR 20CM CDC-45703-XPN1A","code_information":[{"code":"27201751","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1493.5,"discounted_cash":373.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INFUSION PHENOM 30CMX.040INX.036INX.027IN FG15150-0630-1S","code_information":[{"code":"27201751","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":11307.55,"discounted_cash":2826.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INFUSION PHENOM MICRO STRAIGHT 150CM FG13150-0615-2S","code_information":[{"code":"27201751","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":11307.55,"discounted_cash":2826.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY CATHETER TRIFUSION HICKMAN 19CM 12FR 0609190","code_information":[{"code":"27201751","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.6,"discounted_cash":391.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER POWER-TRIALYSIS STRAIGHT 13FR 15CM 5603150","code_information":[{"code":"27201752","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1574.66,"discounted_cash":393.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ECHOCARDIOGRAPHY VERISIGHT INTRACARDIAC 2D VSICE2D","code_information":[{"code":"27201753","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":25068.15,"discounted_cash":6267.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ULTRASOUND PLATINUM EAGLE EYE .014X150CM-VOLCANO THERAPUTICS","code_information":[{"code":"27201753","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":6442.15,"discounted_cash":1610.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VISIONS PV 0.018 F/X","code_information":[{"code":"27201753","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":5856.5,"discounted_cash":1464.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRASOUND VERISIGHT PRO ICE DEFLECTION 9F 90CM VSICE3D","code_information":[{"code":"27201753","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":28458.0,"discounted_cash":7114.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIONEER PLUS PERIPHERAL ULTRASOUND  6FX120CM-MEDTRONIC","code_information":[{"code":"27201753","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":21343.5,"discounted_cash":5335.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRASOUND NUVISION ICE 10FR FG10593","code_information":[{"code":"27201753","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":31387.5,"discounted_cash":7846.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRASOUND EAGLE EYE GLYDX PLATINUM ST SHORT TAPER 5FR 150CM 20MM 85900PST","code_information":[{"code":"27201753","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":6532.25,"discounted_cash":1633.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ULTRASOUND PERIPH VISIONS PV .035X90CM 8.5F 88901","code_information":[{"code":"27201753","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":8559.5,"discounted_cash":2139.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY LUMBAR PUNCTURE ADULT 648","code_information":[{"code":"27201755","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1755","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.78,"discounted_cash":36.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY LUMBAR PUNCTURE PEDIATRIC W/O MONOMETER 646","code_information":[{"code":"27201755","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1755","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.37,"discounted_cash":24.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANGIOJET ZELANTE DVT 8F 114610-001","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":28600.29,"discounted_cash":7150.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"THROMBECTOMY SOLENT DISTA 4FX15CMX145CM .014 ANGIOJET","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":19527.21,"discounted_cash":4881.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"THROMBECTOMY CLEANER15 7F X135CM ROTATIONAL-ARGON MEDICAL","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":8964.95,"discounted_cash":2241.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER MECHANICAL THROMBECTOMY KIT CATRXKIT","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"THROMBECTOMY CLEANER15 7F X65CM ROTATIONAL-ARGON MEDICAL","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"THROMB PRONTO V4 6FX138CM .014 EXTRACT CATH-VASCULAR SOL","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":3285.7,"discounted_cash":821.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER EMBOLECTOMY STAINLESS STEEL SILICONE 3FR 80CM NL3EMB80","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.4,"discounted_cash":97.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOGARTY ARTERIAL EMBOLECTOMY 2FR 60CM 120602F","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOGARTY ARTERIAL EMBOLECTOMY 4FR 80CM 120804FP","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.01,"discounted_cash":82.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH 3MAX REPERFUSION 3.8FX160CM .035 - PENUMBRA 3MAXC","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":14686.3,"discounted_cash":3671.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOLECTOMY FOGARTY OTW 5.5FX80CM THRU-LUMEN .035 6F-EDWARDS","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"THROMBECTOMY SOLENT OMNI 6FX120CM PERIPH OTW.035-MEDRAD","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":16911.77,"discounted_cash":4227.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPORT AP ASPIRATION CATHETER .014 6 FR- MEDTRONIC","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":4171.5,"discounted_cash":1042.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOGARTY ARTERIAL EMBOLECTOMY 3FR 80CM 120803F","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.9,"discounted_cash":84.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM INDIGO LIGHTNING BOLT SONIC LITNGBT6XTX150","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":54374.4,"discounted_cash":13593.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER LIGHTNING FLASH XTORQ TIP H1 16FR 100X135CM LITNGFXT100H1","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":69171.6,"discounted_cash":17292.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THROMB REPERFUSION ASPRTN TUBING RED 72  L132RED72KIT","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":23394.15,"discounted_cash":5848.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER 12 LIGHTNING BOLT ASPIRATION TUBING 115CM LITNGFB12HT115","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":68534.4,"discounted_cash":17133.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THROMBECTOMY CLOTTRIEVER 12FR 105CM 16MM 42-102","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":40134.15,"discounted_cash":10033.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOGARTY ARTERIAL EMBOLECTOMY 4FR 80CM 120804F","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.9,"discounted_cash":84.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THROMBECTOMY CLEANERXT 6FR 65CM 700009XT","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THROMBECTOMY INDIGO ASPIRATION KIT 7FR CAT7DKIT","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":22347.9,"discounted_cash":5586.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SUCTION THROMBECTOMY ERIC 4 4X30MM ER174030-US","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":42480.0,"discounted_cash":10620.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THROMBECTOMY SMARTCLAW 8F 145CM 20MM FD0660-01","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":33438.15,"discounted_cash":8359.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER LIGHTNING BOLT ASPIRATION TUBING 7F LITNGBT7TQ130","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":56500.17,"discounted_cash":14125.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOGARTY EMBOLECTOMY 5FR 80CM","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.9,"discounted_cash":84.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOGARTY ARTERIAL EMBOLECTOMY 2FR 60CM 120602FP","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.36,"discounted_cash":171.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INFUSION UNI-FUSE 5FRX45CMX10CM INFUSION PATTERN","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1918.89,"discounted_cash":479.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH INDIGO 12 100CM XTORQ + LIGHTNG TUBING LITNG12XTORQ100","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":47931.6,"discounted_cash":11982.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH INDIGO 12 115CM HTORQ + LIGHTNG TUBING LITNG12HTORQ115","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":47931.6,"discounted_cash":11982.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC CATHETER THROMBECTOMY FLOWSAVER BLOOD RETURN SYS 80-101","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Catheter Lightning Bolt 7 LITNGBT7TQ130","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":56498.4,"discounted_cash":14124.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENT SOLITAIRE 10MM SPACE 3-1 L50MM L40MM OD4 SFR4-4-40-10","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":47591.76,"discounted_cash":11897.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ASPIRATION .043IN X 160CM RED43160","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":20339.1,"discounted_cash":5084.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THROMBECTOMY CLOTTRIEVER XL 16FR 10-28MM 41-102","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER THROMBECTOMY ZOOM .083IN 137CM ICRC071137","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":22473.45,"discounted_cash":5618.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOLIZATION WEB DETACHMENT CONTROLLER SYSTEM WDC-2","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.5,"discounted_cash":476.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER LIGHTNING BOLT 12 ASPIRATION CATHETER 12 + TUBING LITNGFB12XT100","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":68534.4,"discounted_cash":17133.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"THROMBECTOMY DEVICE SOLITAIRE REVASCULARIZATION 6X40MM SFR4-6-40-10","code_information":[{"code":"27201757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":47591.76,"discounted_cash":11897.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL COOK CONE TIP 6 FR  G14663 #024605","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.74,"discounted_cash":48.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER OPEN-END URETERAL 5FR X 70CM G14274","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.6,"discounted_cash":35.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":140.33,"discounted_cash":35.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":150.56,"discounted_cash":37.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL LASER 7.1FR 40CM","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.02,"discounted_cash":60.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT URETERAL IRIS W/LIGHTED STENT 0220180518","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":2497.03,"discounted_cash":624.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2472.20,"discounted_cash":618.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL POLYURETHANE CONE TIP 10FR 138010","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL 4FR FLEXIBLE TIP","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.92,"discounted_cash":30.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL ACCESS FLEXI-TIP DUAL LUMEN 10FR 50CM W/6FR TIP","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.09,"discounted_cash":121.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DUAL LUMEN CATHETER #M0064051000","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.88,"discounted_cash":161.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL DUAL LUMEN 10FR X 50CM","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.88,"discounted_cash":161.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CALYXO SYSTEM ASPIRATION CVAC STEERABLE URETERAL CATHETER DISP CVC127020-1","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":29253.15,"discounted_cash":7313.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER FOLEY 2 WAY BALLOON SILVER HYDROGEL COATED 20FR 50CC 0165SI20","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.42,"discounted_cash":15.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL ACCESS DUAL LUMEN 6/10 FR 50CM G17323","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.08,"discounted_cash":143.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETEROSCOPY CONE TIP 8FR","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL TIGER TAIL 5FR X 70CM #139005","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL TIGER TAIL 6FR X 70CM #139006","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL DILATOR 24F 8CM BALLOON M0062251100","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":2236.54,"discounted_cash":559.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER URETERAL 5FR FLEXIBLE TIP #021105","code_information":[{"code":"27201758","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.06,"discounted_cash":30.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRSND ACUSON ACUNAV 8FR 90CM 10135910","code_information":[{"code":"27201759","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":8855.77,"discounted_cash":2213.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRSND ACUSON ACUNAV 10FR 90CM 10043342","code_information":[{"code":"27201759","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":8859.08,"discounted_cash":2214.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRSND SOUNDSTAR 8FR 90CM 10439236","code_information":[{"code":"27201759","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":13225.44,"discounted_cash":3306.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRSND SOUNDSTAR 10FR 90 CM 10439072","code_information":[{"code":"27201759","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":11459.79,"discounted_cash":2864.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE ATRICLIP FLEXV 1 HAND SMALL 40MM ACHV40","code_information":[{"code":"27201760","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":16668.5,"discounted_cash":4167.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRASOUND SHOCKWAVE C2 IVL 4.0X12MM C2PIVL4012","code_information":[{"code":"27201761","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":39339.0,"discounted_cash":9834.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER LITHOTRIPSY SHOCKWAVE M5 6FR 5.5X60MM M5PIVL5560","code_information":[{"code":"27201761","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":28876.5,"discounted_cash":7219.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER LITHOTRIPSY SHOCKWAVE M5 6.5X60MM 110CM M5PIVL6560","code_information":[{"code":"27201761","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":28876.5,"discounted_cash":7219.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRASOUND SHOCKWAVE C2 IVL 3.0X12MM C2PIVL3012","code_information":[{"code":"27201761","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":41797.69,"discounted_cash":10449.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER LITHOTRIPSY 7FR 110CM 9X30MM L6IVL090030","code_information":[{"code":"27201761","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":28876.5,"discounted_cash":7219.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRASOUND SHOCKWAVE C2 IVL 2.5X12MM C2PIVL2512","code_information":[{"code":"27201761","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":39339.0,"discounted_cash":9834.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ULTRASOUND SHOCKWAVE C2 IVL 3.5X12MM C2IVL3512","code_information":[{"code":"27201761","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":39339.0,"discounted_cash":9834.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH AGILIS NXT STEERABLE 8.5FX71CM MED CURL INTRO-ST JUDE","code_information":[{"code":"27201766","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":8054.94,"discounted_cash":2013.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER AGILIS 8.5FRX61CM CURL SMALL G408318","code_information":[{"code":"27201766","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":8054.94,"discounted_cash":2013.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH CARTO VIZIGO BI-DIRECTIONAL D138502","code_information":[{"code":"27201766","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":8829.8,"discounted_cash":2207.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WATCHMAN TRUSTEER ACCESS DOUBLE CURVE ID12F OD17F M635TU90050","code_information":[{"code":"27201766","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":13515.0,"discounted_cash":3378.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER AGILIS NXT STEERABLE DUAL-REACH 13F 71CM SI-1371-M","code_information":[{"code":"27201766","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":11713.0,"discounted_cash":2928.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH AGILIS NXT DUAL-REACH MEDIUM CURL 71CM G408321","code_information":[{"code":"27201766","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":8054.94,"discounted_cash":2013.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH AGILIS J-TIP CURL LRG 8.5X24MM G408324","code_information":[{"code":"27201766","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":8054.94,"discounted_cash":2013.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR MIRACLEBROS 12 SILICONE HYDROPHOBIC STRAIGHT .014IN 11X300CM AG14M370","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPINCTEROTOME DIRECT ACCESS SYSTEM DASH-480 #G25227","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.7,"discounted_cash":615.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE CAPITAL FRAGMENT 1.6X150MM AR-8741-16","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.7,"discounted_cash":126.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE BEVEL FULL THREAD 1.6X4MM AR-8741-15","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.7,"discounted_cash":126.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE ORTHOPEDIC THIN SINGLE TROCAR 00.9X150MM 35-0027","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.2,"discounted_cash":164.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INFRAME INSTRUMENT GIDEWIRE TROCAR EXINF912000","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE WIRE TROCAR SIBER TITANIUM 3.2X300MM 5040-200","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1184.5,"discounted_cash":296.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE NONTHREAD 1.6X150MM 1100-0160","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE ENDOSCOPIC JAGWIRE ANGLED TIP 260CM .025IN M00556490","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.05,"discounted_cash":240.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIXATION KIRSCHNER LONG SMOOTH TIP 1.2X150MM 707091202","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE K-WIRE FIXATION NITINOL BLUNT TIP 1.4X480MM 100.7009","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE WIRE SIBER TI BLUNT STACKABLE 3.2X300MM 5040-213","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE ASAHI MIRACLEbros 3  .014 X 300cm-ABBOTT","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIELDER XT .014 X 190cm-ABBOTT","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIELDER XT .014 X 300cm-ABBOTT","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"JAGTOME RX 39-20-450-.025 #7309","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3079.7,"discounted_cash":769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE ROTAWIRE DRIVE FLOPPY 330X2.2CM H74939462005","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1804.56,"discounted_cash":451.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE PERIPH. ADVANTAGE NITINOL CORE .035 X 180CM-TERUMO","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2314.41,"discounted_cash":578.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1611.33,"discounted_cash":402.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES GUIDEWIRE SMOOTH FLUTED 2.8X300MM 292.81","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1343.22,"discounted_cash":335.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX GUIDEWIRE TROCAR TIP 1.35 X 130MM AR-8943-01","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.3,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GLIDEWIRE ANGLED .018 X 180CM-TERUMO","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.63,"discounted_cash":138.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE ORTHOPEDIC TROCAR TIP 1.4X150MM 03.333.002","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1093.86,"discounted_cash":273.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDEWIRE STIFF SHAFT 0.035IN X 150CM STRAIGHT #46-306B","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.7,"discounted_cash":100.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES GUIDEWIRE THREADED 1.25X150MM 900.722","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.05,"discounted_cash":98.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES GUIDE WIRE THREADED TROCAR POINT 2.8 X 300MM 292.68","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.67,"discounted_cash":151.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE SPECIMEN V18-01 8/150","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.6,"discounted_cash":211.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE BENTSON 150CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE PERIPH. ADVANTAGE NITINOL CORE .035 X 260CM-TERUMO","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1798.79,"discounted_cash":449.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1751.0,"discounted_cash":437.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE SYNCHRO2 .014X200CMX35CM SOFT PRE-SHAPED -STRYKER","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":6071.99,"discounted_cash":1518.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE SYNCHRO2 .014 X35CMX200CM STANDARD -STRYKER","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":6113.1,"discounted_cash":1528.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR NITINOL STANDARD 215X45CM SSTD215STR","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":6113.1,"discounted_cash":1528.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE STEERABLE STORQ 0.035IN 180CM LONG SOFT ANGLED TIP 503-356J","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.84,"discounted_cash":122.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE SENSOR 0.035 STRAIGHT M0066703081","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.33,"discounted_cash":105.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE JAGUAR STRAIGHT 0.025 450CM #M00556560","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1071.2,"discounted_cash":267.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHINCTEROTOME ULTRA TAPER W/20MM CUTTING WIRE","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1792.2,"discounted_cash":448.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AMPLATZ SUPER STIFF STRAIGHT TIP GUIDEWIRE M00550090","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE BILIARY STRAIGHT TIP 0.035 450CM M00556581","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2142.4,"discounted_cash":535.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"0.025 260CM STRAIGHT TIP GUIDEWIRE M00556201","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.64,"discounted_cash":254.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GUIDE HYDRA JAGWIRE .035 STRAIGHT 260CM #M00556001","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE URO SAVARY-GILLIARD 200CM G57280","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"JAGWIRE REVOLUTION STRAIGHT TIP PERFORM QUIDEWIRE M00557020","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"JAGWIRE REVOLUTION ANGLE TIP 0.025x450 M00557030","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.73,"discounted_cash":189.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE STARTER BENTSON PTFE STRAIGHT TAPER STANDARD 0.038IN 15X150CM M001491461","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHINCTEROTOME CANNULATED 3.9FR 20MMX5MM M00545190","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2109.65,"discounted_cash":527.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FUSION WIRE GUIDE LOCKING DEVICE  G31522 FS-WL-O-S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.31,"discounted_cash":38.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE TRACER METRO DIRECT METII-21-480 G26862","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1538.02,"discounted_cash":384.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE STAINLESS STEEL NONTHREAD SPADE POINT 2X230MM 292.656","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.03,"discounted_cash":127.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GLIDEWIRE STRAIGHT STIFF .035 X260CM-TERUMO","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.48,"discounted_cash":126.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":569.28,"discounted_cash":142.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GUIDE J FIXED CORE .021 X 180CM-COOK","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.00,"discounted_cash":43.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE NITREX .018 X 80 X 5CM -EV3","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.7,"discounted_cash":145.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE IRON MAN HI-TORQUE .014 X300CM-ABBOTT VASCULAR","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.8,"discounted_cash":195.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FATHOM 0.014 STEERABLE GUIDEWIRE 200CM X 10 CM-BSCI","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3532.9,"discounted_cash":883.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX GUIDEWIRE WITH TROCAR TIP 1.35MM AR-8737-01","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE UROLOGICAL SENSOR 0.0035INX150CM M0066703080","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1877.18,"discounted_cash":469.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1877.18,"discounted_cash":469.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES GUIDEWIRE SMOOTH 1.1X150MM 292.623","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.55,"discounted_cash":93.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FATHOM 0.016 STEERABLE GUIDEWIRE 180CM X 10 CM-BSCI","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2880.91,"discounted_cash":720.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GLIDE GT STANDARD ANG 45 DEGREE .018X180CM-TERUMO","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.6,"discounted_cash":442.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GLIDE GT STANDARD ANG 90 DEGREE .018X180CM-TERUMO","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.6,"discounted_cash":442.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE AMPLATZ 0.035 150CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.33,"discounted_cash":60.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GUIDE AMPLATZ SUPER STIFF .035 X 180","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.96,"discounted_cash":85.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR NITINOL STND PRESHAPE 215X45CM SSTD215PRE","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":6095.59,"discounted_cash":1523.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE SYNCHRO SELECT STRAIGHT 215X35CM SSFT215STR","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":6113.1,"discounted_cash":1528.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE BMW 0.14IN 3X190CM 1001780","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.8,"discounted_cash":195.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET TRAUMA GUIDE WIRE BALL NOSE 100CM 281001100","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.34,"discounted_cash":289.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE WIRE BALL TIP 3X1000MM #1806-0085S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2379.3,"discounted_cash":594.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GUIDE 074112","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.39,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE FIXED CORE STRAIGHT .97MM X 145CM FLEXIBLE SOFT TIP","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.97,"discounted_cash":58.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE ORTHO TROCAR TIP 1.6IN AR-8941K","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES GUIDE WIRE THREADED 1.6X150MM  292.72","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":451.55,"discounted_cash":112.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES GUIDE WIRE THREADED 2.8  X 450MM  900.726","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.29,"discounted_cash":262.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE BMW UNIVERSAL 0.014 3X300CM  1009661","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.8,"discounted_cash":195.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE POINT GRAPHIX 182CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.01,"discounted_cash":215.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE POINT GRAPHIX 300CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.01,"discounted_cash":215.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE EXTENSION 145CM 0.014/0.018IN","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.8,"discounted_cash":195.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AMPLATZ EXCHANGE 0.035IN 260CM M001465260","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.96,"discounted_cash":85.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDEWIRE HYDROPHILIC COAT 0.035 180CM ANGLED TIP #GR3508","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.91,"discounted_cash":102.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONTROL WIRE W/GUIDE V-18 0.018 300CM 8CM TIP #46-854","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.6,"discounted_cash":211.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE ROSEN 260CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE STEERABLE STORQ 0.035IN 300CM LONG SOFT ANGLED TIP 503-356Y","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":651.68,"discounted_cash":162.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GUIDE LUNDERQUIST X-STIFF STRGHT 260CM #TSMG-35-260-LES","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2014.68,"discounted_cash":503.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE SPRING-WIRE 0.032IN X 60CM STR SOFT TIP END AW-04432","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.76,"discounted_cash":23.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR GLIDEWIRE ADVANTAGE TRACK NITINOL 0.014IN 300CM GAT1430","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3636.93,"discounted_cash":909.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR INQWIRE PTFE RADIUS STANDARD J 3MM 0.035IN 150CM IQ35F150J3","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.83,"discounted_cash":15.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR GLIDEWIRE GT NITINOL TUNGSTEN STANDARD 0.018IN 25X180CM RG*ES1818SP","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2049.91,"discounted_cash":512.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR ASTATO XS 20 SLIP-COAT STRAIGHT .014IN 17X300CM PAGH143392","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR AMPLATZ SUPER STIFF .035INX75CM M001465630","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.96,"discounted_cash":85.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE J CURVE 180CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.9,"discounted_cash":33.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR 0.014IN DIA 80CML 5CML NITINOL N140801","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.4,"discounted_cash":200.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE MEDIUM WEIGHT 300CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.8,"discounted_cash":195.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE HI-TORQUE SUPRACORE 300CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.24,"discounted_cash":186.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE STEELCORE 190CM 1003281","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.24,"discounted_cash":186.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE PERIPHERAL HI-TORQUE STEELCORE 300CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.24,"discounted_cash":186.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE HI-TORQUE SPARTACORE 190CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.24,"discounted_cash":186.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE HI-TORQUE SPARTACORE 5X300CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.24,"discounted_cash":186.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR STARTER ROSEN PTFE STANDARD TAPER J CURVE .035IN 4X180CM 1.5MM M001491561","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.86,"discounted_cash":37.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE ASTATO XS 20 GW .014INX180CM STRAIGHT PAGH143092","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR SILIVERWAY J SHAPE .035IN 260CM SJ1535N26S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":103.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR ARISTOTLE NITINOL SOFT .024IN A24-200-001","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":6622.35,"discounted_cash":1655.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR ARISTOTLE SOFT .018IN 200CM A18-200-001","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":5676.3,"discounted_cash":1419.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE HYDROPHILI COATING 190CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.8,"discounted_cash":195.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE TROCAR TIP 1.1X150 03.333.001","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.30,"discounted_cash":236.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE-WIRE THREADED 1.9MM CSS-040-19-T","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":36.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE TROCAR TIP 2.4MM DISP AR-8770K","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GUIDE BALL TIP 3X750MM 1806-0080S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2276.3,"discounted_cash":569.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR REUTER .038IN 10MM 110CM G26958","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.9,"discounted_cash":257.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE WIRE AEQUALIS PERFORM 2.5 X 220MM DWD017","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1010.64,"discounted_cash":252.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE (ZIP WIRE) BOSTON ANGLE 0.035X150CM M00146151B0","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE SS THREAD 2.3MM BLUE CSS-040-23","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.1,"discounted_cash":69.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GUIDE FIXED CORE 145CM 638413","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.97,"discounted_cash":58.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX GUIDEWIRE WITH TROCAR TIP 1.1MM AR-8737-41","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GUIDE 3.2MM #357.399","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.22,"discounted_cash":223.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":890.13,"discounted_cash":222.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR STARTER BENTSON 180CM M001491470","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.8,"discounted_cash":41.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDE .035/150 STIFF SHAFT ANGLED TIP M006630223B1","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.84,"discounted_cash":159.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NITREX GUIDEWIRE .014X300CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDEWIRE ANGLED STIFF 180CM 0.035IN GS3508","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.01,"discounted_cash":120.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":482.90,"discounted_cash":120.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GLIDEWIRE STRAIGHT STIFF .035 X180CM-TERUMO","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.01,"discounted_cash":120.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GLIDEWIRE STRAIGHT .035 X 180CM-TERUMO","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.91,"discounted_cash":102.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GLIDEWIRE ANGLED STIFF .035 X260CM-TERUMO","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.53,"discounted_cash":129.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE ASAHI PROWATER .014X300CM-ABBOTT","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE ASAHI PROWATER .014X180CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE AMPLATZ SS GUIDEIWRE .035X75CM-BSCI/SCIMED","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.96,"discounted_cash":85.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE  SUPRACORE .035 X190 CM -ABBOTT","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.24,"discounted_cash":186.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCESSORY INTERV- GUIDEWIRE ACCES KIT WITH COPILOT -ABBOTT","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.2,"discounted_cash":87.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE AMPLATZ SUPER STIFF STRAIGHT TIP SHORT TAPER .035X260CM M001465090","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.96,"discounted_cash":85.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE .018 X 60CM NITINOL MANDRIL #G08427","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.30,"discounted_cash":123.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDEWIRE SHAFT 0.035IN 260CM ANGLED TIP","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.32,"discounted_cash":114.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASC STD BENTSON 80CM G01315","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.4,"discounted_cash":64.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":257.40,"discounted_cash":64.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE RUNTHROUGH IZANAI M COAT STRAIGHT 3X180CM 25-5211","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.3,"discounted_cash":285.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE SPRING-WIRE .64MM X 33CM STRAIGHT SOFT TIP BOTH ENDS","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.4,"discounted_cash":22.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE WIRE BENTSON CEREBRAL 145CM TSFB-35-145 G00691","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.9,"discounted_cash":51.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":205.90,"discounted_cash":51.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE NITIROL HYDRO ANGLED .016IN 215X25CM M001509310","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3532.9,"discounted_cash":883.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR GLADIUS MONGO 0.014IN 300CM AP14R323S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR GLADIUS MONGO 0.014IN 190CM AP14R023S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ASAHI GUIDEWIRE EXTENSION","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.7,"discounted_cash":177.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE SYNCHRO2 SOFT .014 X 300CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":7603.72,"discounted_cash":1900.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORONARY WIGGLE WIRE 190CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.8,"discounted_cash":195.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE TAVR CONFIDA .035X260CM BRECKER CURVE - MEDTRONIC","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":8784.75,"discounted_cash":2196.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE HI-TORQUE COMMAND ES .014X300CM - ABBOTT","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.03,"discounted_cash":365.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE HI-TORQUE COMMAND .014X300CM - ABBOTT","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.03,"discounted_cash":365.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE FIXED CORE STRAIGHT TFE COATED 260CM 0.35 G00655","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.60,"discounted_cash":48.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE ASAHI GRANDSLAM .014X180CM STR-ABBOTT","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE BMW UNIVERSAL .014 3X190CM J TIP HI TORQ 1009660J","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.8,"discounted_cash":195.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE WHOLEY GUIDE MODIFIED J .035X145","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.95,"discounted_cash":157.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASC AMPLATZ EXTRA-STIFF STRAIGHT 80MM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.4,"discounted_cash":64.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":257.40,"discounted_cash":64.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE HI-TORQUE PILOT 50 0.014X190CM 1010480-H","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.8,"discounted_cash":195.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE WIRE FIXED CURVE 0.35X260CM G00517","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.72,"discounted_cash":48.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":195.6,"discounted_cash":48.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE CORONARY RUNTHROUGH HYPERCOAT 0.014IN 180CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.9,"discounted_cash":368.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1469.90,"discounted_cash":367.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE SION BLK FRNTLNE WRKHRSE 0.014IN 300CM APW14R310S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE SION BLK FRNTLNE WRKHRSE 0.014IN 190CM APW14R010S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE SION BLUE FRONTLINE 0.014IN 300CM AHW14R304S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR SION BLUE PTCA 190CM 14IN AHW14R104S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.5,"discounted_cash":244.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASC LUNDERQUIST EXTRA STIFF 15X55MM DISP G53971","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.38,"discounted_cash":578.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE OMNIWIRE STRAIGHT-TIP 185CM 89185","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":5811.45,"discounted_cash":1452.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDEWIRE ADVANTAGE 0.014x180cm GA1418","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3096.9,"discounted_cash":774.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE ENROUTE 0.014IN SR-014-GW","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1493.5,"discounted_cash":373.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE TAVR EXTRA SM PRESHAPED SAFARI H74939406XS1","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE WIRE HI-TORQUE COMMAND 18 10 X 300 1013731","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.03,"discounted_cash":365.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE HYDROPHILIC TIP SENSOR 0.035IN 150CM M0066703010","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.33,"discounted_cash":105.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDE STIFF SHAFT STRAIGHT TIP 150CM .035IN M0066802221","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.19,"discounted_cash":133.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE LOCKING DEVICE AND BIOPSY CAP MAJ-2455","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.54,"discounted_cash":30.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE JAGTOME REVOLUTION CANN SPHINCTEROME M00584250","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4017.0,"discounted_cash":1004.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WILTROM GUIDEWIRE 500mm 70091","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE URO TRITIN SOLO PLUS STIFF 0.035IN HW35SS","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.85,"discounted_cash":125.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHINCTEROTOME CLEVERCUT PRELOAD 2-WIRE KD-VC631Q-07203S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3852.2,"discounted_cash":963.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HYDRA JAGWIRE STRAIGHT 450CM M00556061","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX GUIDEWIRE WITH TROCAR TIP AR-8737-39","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE WITH TROCAR TIP 0.62X9.25 AR-8750K","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AMPLATZ PTFE .038 FLOPPY #M0066401091","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.65,"discounted_cash":63.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SENSOR .035 3CM FLEXIBLE TIP STRAIGHT #M0066703050","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.63,"discounted_cash":100.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"JAGTOME RX 44","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3079.7,"discounted_cash":769.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE AERO AIRWAY SUPER STIFF RADIOPAQUE .035 X 180CM","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHINCTEROTOME ENDOSCOPIC AUTOTOME PRO RX JAGTOME REVOLUTION PRO RX 3.9FR 25MM 450CM M00584480","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4017.0,"discounted_cash":1004.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VISIGLIDE 2 FLUORINE 170X2700MM 0.025IN G-260-2527A","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VISIGLIDE FLUORINE STRAIGHT 7X270CM 0.025IN G-240-2527S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VISIGLIDE FLUORINE STRAIGHT 2700MM 0.035X0.025IN G-240-3527S","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.4,"discounted_cash":406.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE DREAMWIRE NITINOL ROUND STRAIGHT .035IN 260CM M00556101","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE JAGWIRE STRAIGHT .025IN 5X260CM M00556461","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.05,"discounted_cash":240.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DREAMTOME SPHINCTEROTOME 44-20MM/260CM GUIDEWIRE","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4017.0,"discounted_cash":1004.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE WIRE 1.4MM #CSS-040-14","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.6,"discounted_cash":30.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DASH EXTRACTION BALLOON MULTI SIZING #G25620","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1256.6,"discounted_cash":314.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE WIRE BOSTON AMPLATZ SUPER STIFF 0.035INX145CM  640-109","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.65,"discounted_cash":63.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE COOK STRAIGHT TEFLON 0.035INX145CM 635413 G14544","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.56,"discounted_cash":64.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACUMED GUIDEWIRE ACUTRAK 0.94 S 9.25IN 80-0970","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE THREADED 1.25 X 150MM 292.62","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.04,"discounted_cash":87.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACUMED GUIDEWIRE ACUTRAK 0.62 X 9.25IN 80-0950","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.4,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRAY TRACHEOSTOMY PRECUTANEOUS SZ FLEX 8.5 BLUE RHINO G57717","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":5416.81,"discounted_cash":1354.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BLUE RHINO TRACH 7.5-9MM W/SHILEY FLEX G57703","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4753.45,"discounted_cash":1188.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE GLIDE GT STANDARD DOUBLE ANGLE .018X180 RG*GW1818SP","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.6,"discounted_cash":442.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHINCTEROTOME ENDO HOWELL DASH 25MM G25790","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.7,"discounted_cash":615.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR HYDRO 260X3CM .018 ANGLED FLEXIBLE TIP","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.2,"discounted_cash":190.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE HYDRA JAGWIRE STD 450CM STRAIGHT M00556041","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDEWIRE NITINOL STANDARD J-TIP 1.5MMX180CM GR3525","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.91,"discounted_cash":102.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR ZIPWIRE ANGLED 0.035 150CM UWS6035","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.74,"discounted_cash":111.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR ZIPWIRE STRAIGHT 0.025 150CM UWSS5125","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.27,"discounted_cash":113.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR ZIPWIRE STRAIGHT 0.035 150CM UWS1035","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.74,"discounted_cash":111.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE AMPLATZ SS .038 260CM  STR TIP 6CM  - BOSTON","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.82,"discounted_cash":109.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE AMPLATZ ULTRA TFE 0.035IN X 260CM THSF-35-180-AUS","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.4,"discounted_cash":90.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WAYNE PNEUMOTHORAX SET 14FR / 29CM G56535","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2585.3,"discounted_cash":646.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDEWIRE VASCULAR ZIPWIRE ANGLED 0.025 150CM UWS5125","code_information":[{"code":"27201769","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.27,"discounted_cash":113.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT SNARE GOOSE NECK AMPLATZ 15MM","code_information":[{"code":"27201773","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2760.4,"discounted_cash":690.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE AMPLATZ GOOSENECK NITINOL KIT 6FR 25MM 120X102CM GN2500","code_information":[{"code":"27201773","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2760.4,"discounted_cash":690.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ENSNARE 9MM-15MM 175CM -MERIT MEDICAL","code_information":[{"code":"27201773","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":3313.92,"discounted_cash":828.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ENSNARE 4MM-8MM 175CM -MERIT MEDICAL","code_information":[{"code":"27201773","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":5542.05,"discounted_cash":1385.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE SHEATH HANDLE SNARE ENDOSCOPIC LESIONHUNTER NITINOL 230CM 2.3X10MM CS50051","code_information":[{"code":"27201773","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.32,"discounted_cash":37.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SNARE ENSNARE MINI 2-4MMX150CM 3.2F - MERIT MEDICAL","code_information":[{"code":"27201773","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":5542.05,"discounted_cash":1385.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RETRIEVAL SET VENA CAVA FILTER GUNTHER TULIP 6.3FR","code_information":[{"code":"27201773","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":3625.5,"discounted_cash":906.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MORCELLATOR ROTATION WITH POWER STICK 4.75MM 49700113","code_information":[{"code":"27201782","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1782","type":"HCPCS"}],"standard_charges":[{"gross_charge":3613.03,"discounted_cash":903.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MYOSURE MORCELLATOR TISSUE REMOVAL SYSTEM 50-503XL","code_information":[{"code":"27201782","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1782","type":"HCPCS"}],"standard_charges":[{"gross_charge":8782.95,"discounted_cash":2195.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROGRAMMER VERIFY EXTERNAL STIMULATOR INTERSTIM 353101","code_information":[{"code":"27201787","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":4532.0,"discounted_cash":1133.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ON-CONTROL BONE MARROW BIOPSY TRAY 102MM","code_information":[{"code":"27201830","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.59,"discounted_cash":330.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ON-CONTROL BONE ACCESS TRAY COAXIAL NEEDLES 10CM 10GA ACCESS","code_information":[{"code":"27201830","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":3812.34,"discounted_cash":953.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE MARROW BIOPSY SYSTEM COMPREHENSIVE TRAY 9458-VC-006","code_information":[{"code":"27201830","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1423.25,"discounted_cash":355.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ELCA CORONARY LASER ATHERECTOMY RX .014 IN L130 CM OD.9 MM ODSEC.038 IN 110-004","code_information":[{"code":"27201885","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":19669.5,"discounted_cash":4917.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OSTEOCOOL PROBE 15mm OCP215","code_information":[{"code":"27201886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":38156.57,"discounted_cash":9539.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANTENNA ABLATION EMPRINT PERCUTANEOUS 15CM CA15L2","code_information":[{"code":"27201886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":27570.78,"discounted_cash":6892.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE ABLATION 20CM 15G PR20XT","code_information":[{"code":"27201886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":19259.37,"discounted_cash":4814.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE OSTEOCOOL 10MM OCP210","code_information":[{"code":"27201886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":38156.57,"discounted_cash":9539.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ABLATION HALO 90-9100","code_information":[{"code":"27201886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":13920.45,"discounted_cash":3480.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SONABLATE INSERTION PROCEDURE KIT 404-14500-0003","code_information":[{"code":"27201886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":20925.0,"discounted_cash":5231.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NANOKNIFE PROBE PACK 5 X 15CM 3.0 H787204001110","code_information":[{"code":"27201886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":9010.0,"discounted_cash":2252.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE ABLATION INTRACEPT RADIO FREQUENCY RLV 0015","code_information":[{"code":"27201886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":36995.4,"discounted_cash":9248.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGNOSTIC GLIDECATH ANG 5F X 65CM .038-TERUMO","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.26,"discounted_cash":139.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER TEMPO BERENSTEIN II 5F X 125CM SRD6565","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.13,"discounted_cash":77.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING SELECTRA 3D-55-39 443627","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC SOFT-VU ANGLE CURVE 4FR 40CM H787107343010","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.68,"discounted_cash":44.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SOFT-VU KUMPE 5FR X 65CM .038 H787107327135","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.68,"discounted_cash":44.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SOFT-VU COBRA C2 5FRX65CM 0.038 BRAID H787107091085","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.52,"discounted_cash":47.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER MICRO PROGREAT 2.8FRX150CM ROMARKER MCPV2815Y","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3399.0,"discounted_cash":849.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SIZING ACCUVU OMNI FLUSH 5FR 70CM 13709701","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1658.3,"discounted_cash":414.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGNOSTIC GLIDECATH ANG 5F X 100CM .038-TERUMO","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.26,"discounted_cash":139.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGNOSTIC GLIDECATH ANGLED 4FX65CM .038-TERUMO","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.26,"discounted_cash":139.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGNOSTIC SOS OMNI 5FX80CM .038-ANGIODYNAMICS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.52,"discounted_cash":47.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INTERVENTIONAL PROGREAT 2.8FR 130CM MC*PB2813Y","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3399.0,"discounted_cash":849.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER NAVICROSS HYDROPHILIC 12MM X 90CM NC35901","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2387.13,"discounted_cash":596.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER NAVICROSS RADIOPAQUE 60MM X 150CM NC18151","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2387.13,"discounted_cash":596.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC SOFT-VU PIGTAIL CURVE 5FR 90CM H787107085025","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC SOFT-VU ROSCH INFERIOR MESENTRIC CURVE 5FR 65CM H787107333015","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.52,"discounted_cash":47.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC SOFT-VU ANGLE KUMPE CURVE 4FR 65CM H787107140145","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.68,"discounted_cash":44.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGNOSTIC GLIDECATH ANGLED 4FRX120CM CG417","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.26,"discounted_cash":139.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING LAUNCHER NYLON IMA CURVE 7FR 55CM LA7IMAK","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER TRUSELECT 2FR BERN 130CM M001394111300","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6892.65,"discounted_cash":1723.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH CORO GUIDELINER 20CMX145CMX.056 RX 6F-VASCULR SOLTNS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4171.5,"discounted_cash":1042.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":4166.35,"discounted_cash":1041.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC GLIDECATH RADIFOCUS 5FR 100CM CG512","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.26,"discounted_cash":139.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP SIM 2 CURVE 5FR 125CM G13200","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.34,"discounted_cash":157.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP 5FR 125CM G12082","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.34,"discounted_cash":157.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING SOFIA STRAIGHT DISTAL ACCESS SHAPE MANDREL 5FR 115CM DA5115ST","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":11777.87,"discounted_cash":2944.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER INFUSION TRINAV 2.4FR 120CM TNV-21120-35","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":54870.0,"discounted_cash":13717.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING CORONARY 100CM X 6FR LA6JR40SH","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIO INFINITI 125CM X 5FR SRD6648","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.63,"discounted_cash":86.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC SAPIEN COMMANDER DELIVERY SYSTEM 29MM 9750CM29","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER GUIDING FINECROSS M3 CORONARY 0.61MM 75X130CM M3-1430","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4820.4,"discounted_cash":1205.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING DESTINATION 7FR 5X45CM RSR04","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.7,"discounted_cash":177.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO EBU4.0 7FX100CM LAUNCHER .081-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.65,"discounted_cash":117.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGNOSTIC CORO. PIG ANG6FX110CM INFINITI TL-CORDIS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.30,"discounted_cash":26.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO MP1 7FX100CM LAUNCHER .081-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGNOSTIC CORONARY JR4 5F X 100CM-CORDIS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING ACUITY PRO 90 CURVE 7FR 60CM 8101","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2523.5,"discounted_cash":630.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO AL1.0 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JL3.5 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.53,"discounted_cash":117.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JL4.0 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JR3.5 6FX100 LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JR4.0 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JR4.0 7FX100CM LAUNCHER .081-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO EBU3.5 7FX100CM LAUNCHER .081-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CXI SUPPORT 2.6F      .035 X 90CM DAV-COOK","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING MERIT IMPRESS VRT 5FR 75CM 1628-017M","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1062.96,"discounted_cash":265.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATH INFUSE DIREXION 2.8-3FR .027IN 155CM M001195420","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5463.48,"discounted_cash":1365.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAG CORO STR PIG 6FX110CM INFINITI TL-CORDIS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.80,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOLIZATION RENEGADE HIFLO FATHOM 16 135CMX20CM KIT BSCI","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6110.31,"discounted_cash":1527.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGNOSTIC GLIDECATH ANGLED 4FX100CM .038-TERUMO","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.26,"discounted_cash":139.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER QUICK CROSS SUPPORT CATHETER .014 X 150CM-SPECTRANE","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO AL1.0 7FX100CM LAUNCHER .081-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER QUICK CROSS SUPPORT CATHETER .018 X 135CM-SPECTRANE","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER QUICK CROSS SUPPORT CATHETER .035 X 150CM-SPECTRANE","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO EBUS3.5 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":473.36,"discounted_cash":118.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO EBUS4.0 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDING CATHETER XB3 6 FR X100 .038 VISTA BRITE TIP-CORDIS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.52,"discounted_cash":116.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDING CATHETER XB3.5 6 FR X100 .038 VISTA BRITE TIP-CORDIS 6700540E","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.52,"discounted_cash":116.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDING CATHETER XBLAD3.5 6 FRX100 .038 VISTABRITETIP-CORDIS 67006000M","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.52,"discounted_cash":116.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAGN PIGTAIL 145 ANGLED DUAL 6FR .038X110-LANGSTON","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1781.9,"discounted_cash":445.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CXI SUPPORT 4.0F .035X135CM STRAIGHT-COOK","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CXI SUPPORT 4.0F .035X135CM DAV ANGLED-COOK","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER QUICK CROSS SUPPORT CATHETER .018 X 150CM-SPECTRANE","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER PERIPHERAL GUIDING VISTA BRITE TIP IG SM RENAL CURVE 8FR 55CM 403-8553R","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":855.11,"discounted_cash":213.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SUPER TORQUE SIM 1 CURVE IODINE 6FR 100CM 455660","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.43,"discounted_cash":50.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC SAPIEN COMMANDER DELIVERY 20MM 975CM20A","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING SELECTRA 115D 7FR 39CM 443629","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDE RADIAL 106f-071-95","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":11199.43,"discounted_cash":2799.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER INFUSION PROGREAT LAMBDA STRAIGHT 165CM CC*M1916SN","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7090.87,"discounted_cash":1772.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC TRICLIP 4TH GENERATION STEERABLE GUIDE CATHETER TSGC0201","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING R2P DESTINATION SLENDER STRAIGHT 6FR 119CM GS-R6ST1C12W","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2657.4,"discounted_cash":664.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SUPPORT TRAILBLAZER 4FRX135CM ASC-035-135","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.38,"discounted_cash":475.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER REPERFUSION RED 43 138CM RED43138","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":20339.1,"discounted_cash":5084.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SUPPORT CXI STRAIGHT TIP BRAID 2.3FR 150CM G18373","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER NAVICROSS HYDROPHILIC 12MM X 135CM NC35130","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2387.13,"discounted_cash":596.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER AGILIS NEXT STEERABLE 13F 71CM SI-1371-S","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":11713.0,"discounted_cash":2928.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER TORCON NB ADVANTAGE BEACON CURVE 5FR 65CM G08444","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.78,"discounted_cash":66.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER IMPRESS SS HYDROPHILIC BERN CURVE BRAID 5FR 125CM 512538BER-H","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.1,"discounted_cash":121.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER TORCON NB ADVANTAGE BEACON SS DAV CURVE 5FR 125CM G11375","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.78,"discounted_cash":66.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC CATHETER STEERABLE GUIDE MITRACLIP G5 SGC0801","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC CATHETER GUIDE STEERABLE TRICLIP G5 TSGC0801","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING ACUITY PRO CORONARY SINUS 9FR 54CM 8104","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5098.5,"discounted_cash":1274.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INFINITI VESTAN SS AL2 CURVE 5FR 100CM 534-546T","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.4,"discounted_cash":26.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER TORCON NB ADVANTAGE SS RIM CURVE 5FR 100CM G12870","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.78,"discounted_cash":66.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC SOFT-VU ANGLE KUMPE CURVE 5FR 65CM .038IN 10732701","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.68,"discounted_cash":44.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER VIA 17 DISPOSABLE 90D 0.0175INX154CM VIA-17-154-90","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":10947.15,"discounted_cash":2736.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDE ATTAIN II 130DEG 7.1FR 57CM 6248V-130P","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2492.6,"discounted_cash":623.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER QUICK CROSS .035 X 135CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER INFUSION HEADWAY DUO HYDROPHILIC STRAIGHT 156CM MC162156S","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7122.40,"discounted_cash":1780.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SIM 2 SIDEWINDER II 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.43,"discounted_cash":50.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET CATHETER JL3.5 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.06,"discounted_cash":22.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":90.13,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER INFUSION PROGREAT LAMBDA ANGLED 1.9FR 165CM CC*M1916AN","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7289.09,"discounted_cash":1822.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET CATHETER JL5 6FR 100CM 532622","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.13,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET CATHETER JL4.5 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.63,"discounted_cash":112.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET CATHETER MPA2 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.97,"discounted_cash":24.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":98.26,"discounted_cash":24.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET CATHETER MPB2 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.89,"discounted_cash":20.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET CATHETER LCB 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.13,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER JUDKIN RIGHT 4 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.00,"discounted_cash":22.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":90.13,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER STP JR5 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.44,"discounted_cash":22.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER STP AL2 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.13,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER STP AL3 6FR 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.89,"discounted_cash":20.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING MPA-1 8FR 0.088 55CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.1,"discounted_cash":218.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING HSTICK 8FR 0.088 55","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.1,"discounted_cash":218.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING RDC IODINE 8FR 0.088 55CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.1,"discounted_cash":218.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING RDC 8FR 0.088IN 55CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.1,"discounted_cash":218.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER JUDKIN RIGHT 4 6FR 55CM 67008255","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.66,"discounted_cash":146.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDING PER CURVED 7FR 55CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.68,"discounted_cash":155.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ELLIPSYS VASCULAR ACCESS 6FR  AMI6005","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":63366.0,"discounted_cash":15841.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIOGRAPHIC IMPRESS 5FR 65CM 56538CB2","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.42,"discounted_cash":27.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIO SUPER TORQUE POLY JR4 6FRX125CM SR3055","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.63,"discounted_cash":86.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAG CORO IMA 6FX100CM .038-MERIT MEDICAL","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.19,"discounted_cash":20.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH QUICKCROSS SUPPORT CATH .035X90CM-SPECTRANETICS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CXI SUPPORT 4FX90CM STRAIGHT .035 - COOK","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1709.8,"discounted_cash":427.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH DIAG PERPH OMNIFLUSH SOFT-VU 5FX65CM .038-ANGIODYNANICS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.68,"discounted_cash":44.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAG CORO TIGER RADIAL TIG 4MMX100CM 5F-TERUMO","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.44,"discounted_cash":92.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH NEURON SELECT BER 9CMX130CM 5F .040 - PNS5F130BER","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER CATHETER ATTAIN COMMAND - MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2859.28,"discounted_cash":714.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER CATHETER ATTAIN SELECT II - MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2492.6,"discounted_cash":623.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER GUIDE CATH ATTAIN COMMAND 45CM MP RIGHT 6250V-MPR","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2859.28,"discounted_cash":714.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER GUIDE ATTAIN COMMAND SELECT II X90CM STD - MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2492.6,"discounted_cash":623.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO IMA 6FX90CM LAUNCHER .071 - MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.21,"discounted_cash":116.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBO DIREXION HIFLO FATHOM16 130CM BERN MICROCATH -BSCI","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8697.8,"discounted_cash":2174.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBO DIREXION FATHOM16 130CM BERN X180CM MICROCATH -BSCI","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8697.8,"discounted_cash":2174.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDE ACUITY PRO OUTER 9FR 45CM 8105","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5098.5,"discounted_cash":1274.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO AL2.0 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO AL 0.75 8FX100CM  LAUNCHER .090 -MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER GUIDE ACUITY PRO 7FX60CM-BSCI 8103","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2523.5,"discounted_cash":630.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER CATHETER ATTAIN COMMAND X45S","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2859.28,"discounted_cash":714.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE RENAL LAUNCHER IMA 6FX55CM-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE RENAL LAUNCHER RDC 6FX55CM DOUBLE CURVE-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH CORO FINECROSS M3 2.5FX150CM .014 MICROGUIDE-TERUMO","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4820.4,"discounted_cash":1205.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAG CORO MPA2 5FX125CM INFINITI-CORDIS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO AL.75 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JL5.0 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO EBU3.0 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.40,"discounted_cash":118.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO AR1.0 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JR5.0 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO 3DRC 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO MB1 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JL3.0 6FS100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO MP1 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH DIAG CORO JACKY3.5 RADIAL 5FX110CM OPTITORQUE-TERUMO","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.38,"discounted_cash":92.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JL4.0 7FX100CM LAUNCHER .081-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO LAUNCHER JR 3.5 7FRX100CM LA7JR35","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO AL2.0 8FX100CM LAUNCHER .091-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DIAG CORO PIG ANG 5FX110CM INFINITT.038-CORDIS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.5,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JR3.5 8FX100CM LAUNCHER .091-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.68,"discounted_cash":117.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO JR4.0 8FX100CM LAUNCHER .091-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AAA ENDOGUIDE STEERABLE16FX62CM HELIFX-APTUS ENDOSYSTEMS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":15866.61,"discounted_cash":3966.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO XBLAD3.0 6FX100CM VISTA BRITE .070 - CORDIS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.60,"discounted_cash":116.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO EBU3.0 7FX100CM LAUNCHER .081 - MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO LCB 6FX100CM LAUNCHER .071-MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.6,"discounted_cash":108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO AL 0.75 7FX100CM  LAUNCHER .081 -MEDTRONIC","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER TRUSELECT 2FR STRAIGHT 155CMM001394101550","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6892.65,"discounted_cash":1723.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER TRUSELECT 2FR STRAIGHT 175CM M001394101750","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7298.1,"discounted_cash":1824.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH CORO GUIDELINER 20CMX145CMX.062 RX 7F-VASCULR SOLTNS","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4171.5,"discounted_cash":1042.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER TRUSELECT 2FR BERN 155CM M001394111550","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6892.65,"discounted_cash":1723.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER TRUSELECT 2FR BERN 175CM M001394111750","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7298.1,"discounted_cash":1824.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDEZILLA II 6FR H7493933515060","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SUPPORT SOFIA PLUS 6FR 19X131 DA6131ST","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":17983.96,"discounted_cash":4495.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORSAIR PRO MICROCATHETER 150CM CSR150-26P","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7162.95,"discounted_cash":1790.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORSAIR MICROCATHERTER  LO-PRO XS 2.1FR 135CM CSR135-21S","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7162.95,"discounted_cash":1790.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIO SUPER TORQUE POLY SIM 2 6FX125CM SRD5471","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.01,"discounted_cash":73.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER INFUSION CORSAIR PRO 2.6FR 135CM CSR135-26P","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7162.95,"discounted_cash":1790.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORO LAUNCH EBU 3.75 6FX100CM .071-MEDTRONIC LA6EBU375","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ANGIO SUPER TORQUE POLY JL4 6FX125CM SR3056","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.63,"discounted_cash":86.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER GUIDE ADROIT JR4 6FRX125CM 67208225","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.52,"discounted_cash":116.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"REPERFUSION ASPIRATION TUBING RED 62 KIT 128CM RED62SKIT","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":23394.15,"discounted_cash":5848.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER DELIVERY SYS BERENSTEIN 6FR 125X90CM BMX9690BER125","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8784.75,"discounted_cash":2196.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER INFUSION SASUKE TAPER TIP SS HYDRO 145CM SA145-33N","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4377.5,"discounted_cash":1094.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC STEERABLE GUIDE CATHETER SGC0701","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICROCATHETER TRUSELECT 2FR STRAIGHT 130CM M001394101300","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6892.65,"discounted_cash":1723.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER TEMPO BERENSTEIN II 5FX100CM 451515H0","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.43,"discounted_cash":50.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC SAPIEN COMMANDER DELIVERY 23MM 9750CM23A","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICRO CATHETER DIREXION .021x155cm M001195350","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5900.56,"discounted_cash":1475.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DIREXION J SHAPE 3.0/2.4F X 155CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5463.48,"discounted_cash":1365.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SIM II 5F X 100CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.43,"discounted_cash":50.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC SAPIEN COMMANDER DELIVERY 26MM 9750CM26A","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SOFIA DISTAL ACCESS 5FX125CM DA5125ST","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":11777.87,"discounted_cash":2944.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CXI SUPPORT  2.6F .018x150CM-COOK G56552","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1751.0,"discounted_cash":437.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SWIFT NINJA STEERABLE MICROCATHETER MIV-20500","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":21092.4,"discounted_cash":5273.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SOFIA 6F X 125CM","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":17983.96,"discounted_cash":4495.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CORONARY JR4.0 8FX90CM LAUNCHER","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.86,"discounted_cash":118.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SOFT-VU KUMPE 5FR X 100CM .038 H787107327030","code_information":[{"code":"27201887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.68,"discounted_cash":44.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RFA CHANNEL ENDOSCOPIC CATHETER TTS-1100","code_information":[{"code":"27201888","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1888","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE (ORDER X10) FIAPC FIRE STRAIGHT","code_information":[{"code":"27201889","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2497.75,"discounted_cash":624.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE ELECTROSURGICAL NANO KNIFE SINGLE 15CM H787204001090","code_information":[{"code":"27201889","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29295.0,"discounted_cash":7323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INDIGO LITNG FLASH KIT 115CM HTORQ 16F SLECT CATH 135BER LITNGFHT115H1","code_information":[{"code":"27201889","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":69136.2,"discounted_cash":17284.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC INTRODUCER SHEATH OPTISEAL  7F 13CM 1000093002","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH PEEL AWAY INTRODUCER SET 18F X 15.5CM .038-COOK","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER SHEATH OPTISEAL VALVE 9FR X 25CM LONG","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.52,"discounted_cash":150.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH PEEL AWAY INTRODUCER SET 20F X 13CM .038-COOK","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER WORLEY 9FX40CM CSGWORBC19M","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":13875.4,"discounted_cash":3468.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM INTRODUCER SAFESHEATH II 9FR 13X19.5CM SS9","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":2811.9,"discounted_cash":702.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER TEARAWAY GUIDEWIRE 6FR .038IN 14CM INT-105-06","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.06,"discounted_cash":53.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH PRELUDE SNAP ROBUST VALVE SPLITTABLE 6FR 13CM PLS-1006","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.62,"discounted_cash":89.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH PEEL AWAY INTRODUCER SET 22F X 13CM .038-COOK","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SILHOUETTE PEEL-AWAY 9F X 30CM","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.54,"discounted_cash":125.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SILHOUETTE PEEL-AWAY 7F X 30CM INT-105-25","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.68,"discounted_cash":117.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC INTRODUCER SAFESHEATH II 9F SS9","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC INTRODUCER SHEATH OPTISEAL 6FR 25CM 1000093008","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER SHEATH OPTISEAL VALVED PEELABLE 9FX13CM","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.6,"discounted_cash":133.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PEEL-AWAY MULTIPURPOSE 11FR 30CM","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.7,"discounted_cash":177.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH PICC 1.9FR NEONATE SHEATH1.9","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.9,"discounted_cash":110.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC INTRODUCER SHEATH OPTISEAL 6F 13CML VASC VALVED 1000093001","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTRODUCER PEEL-APART PTFE 6.5FR 0601165","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH PICC 1.4FR SHEATH1.4","code_information":[{"code":"27201892","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.8,"discounted_cash":118.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER ACCESSORY SELECTRA ACCESSORY KIT 375518","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.13,"discounted_cash":305.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC GUIDE SHEATH AND INTRODUCER PASCAL PRECISION 20000GSA","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC ESHEATH INTRODUCER SET 14FR 914AESP","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER SELECTRA EXTENDER HOOK 45 BIOTRONIK","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":2446.25,"discounted_cash":611.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC ESHEATH INTRODUCER SET 16FR 916ESPA","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EP FASTCATH TRANSSEPTAL GUIDE SL1 CURVE 8.5F X 60CM-ST JUDE","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.6,"discounted_cash":391.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER CARRIER DELIVERY SMALL 152CM CR7071","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":18372.15,"discounted_cash":4593.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH FASTCATH SEPT 8.5FR 145X60CM 406894","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDE VERSACROSS KIT VXSK0132","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":8739.7,"discounted_cash":2184.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WATCHMAN FXD CURVE ACCESS SYS DBL US 12X15FR M635TU80020","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING PINNACLE 10FR 2.5X25MM RSS006","code_information":[{"code":"27201893","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.65,"discounted_cash":44.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRYSEAL FLEX SHEATH 20F 33CM GDSF2033","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5252.83,"discounted_cash":1313.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRYSEAL FLEX SHEATH 22F 33CM GDSF2233","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5252.83,"discounted_cash":1313.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ANSEL STRAIGHT TIP 6F X 45CM G44154","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.9,"discounted_cash":136.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 6F X 10CM RSB612","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.55,"discounted_cash":47.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PFO DELIVERY SYSTEM 8FR X 80CM 9-ITV08F45/80","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":7820.68,"discounted_cash":1955.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER 18FX13CM G28327","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":947.6,"discounted_cash":236.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRYSEAL FLEX SHEATH 16F X 33CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4542.3,"discounted_cash":1135.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ACCESS CLEARPETRA URETERAL 12-14FR 46CM XUSM0044","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":7946.82,"discounted_cash":1986.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PINNACLE SHEATH 9FX25CM RSS906","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.65,"discounted_cash":44.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER MICRA 23F 55.7 CATHETER MI2355A","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":1351.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 7F X 10CM RSB712","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.55,"discounted_cash":47.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 6FX25CM RSB603","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE SHEATH 7F X 25MM RSB703","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 8FX25 RSB803","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.8,"discounted_cash":66.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 6F X 6CM RSB611","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.55,"discounted_cash":47.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 7F X 6CM RSB711","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.55,"discounted_cash":47.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 5F X 10CM RSB512","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.55,"discounted_cash":47.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRYSEAL FLEX SHEATH 12F X 33CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4542.3,"discounted_cash":1135.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 8F X 10CM RSB812","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.55,"discounted_cash":47.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 9F X 10CM RSB912","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.55,"discounted_cash":47.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 10F X 10CM RSS004","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.43,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER PINNACLE MARKER SHEATH 11F X 10CM RSS104","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.43,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER SAFESHEATH SS6 398339","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.03,"discounted_cash":159.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER DRYSEAL HYDROPHILIC 18FRX33CM DSF1833","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5252.83,"discounted_cash":1313.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RADIAL GLIDESHEATH SLENDER 6FX10CM  60-1065","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.2,"discounted_cash":242.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":968.14,"discounted_cash":242.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDE VERSACROSS TRANS 63CM 45D D1 8.5F VXS0202","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH/DRYSEAL FLEXSHEATH 12FRx45cm DSF1245","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":7577.41,"discounted_cash":1894.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH FLEXOR CHCKFLO II INTRODUCR 10F X 38.5CM .035","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.18,"discounted_cash":247.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PFO DELIVERY SYSTEM 10 FR X 80 CM- AMPLATZER","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":7820.68,"discounted_cash":1955.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ULTIMUM 9F X 12CM-ST JUDE/DIAG DIVISION","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":24.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ULTIMUM 6F X 23CM-ST JUDE/DIAG DIVISION","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.1,"discounted_cash":69.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH SHUTTLE FLEXOR 6F X 90CM .038-COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1184.5,"discounted_cash":296.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH PEEL AWAY SHORT INTRODUCER 11F X15.5CM .038-COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PFO DELIVERY SYSTEM 9FX80CM-ST JUDE","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":7820.68,"discounted_cash":1955.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH FAST-CATH 12FX12CM .038 INTRODUCER ST JUDE","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.86,"discounted_cash":41.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ULTIMUM HEMOSTASIS INTRODUCER 8FR 12CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":24.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SET MICROPUNCTURE STAINLESS STEEL WIRE W/ECHOTIP","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.5,"discounted_cash":64.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER FLEXOR CHECK-FLO RAABE 8FR 55CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER FLEXOR CHECK-FLO RAABE 6FR 55CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER FLEXOR CHECK-FLO RAABE 7FR 55CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER FLEXOR CHECK-FLO BALKIN UP & OVER 8FR","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.9,"discounted_cash":136.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH BALKIN 6FR X 40CM FLRXOR .038-COOK #G10383","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.9,"discounted_cash":136.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHUTTLE-SL FLEXOR TUOHY-BORST SIDE-ARM 8FR","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.9,"discounted_cash":239.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHUTTLE-SL FLEXOR TUOHY-BORST SIDE-ARM 7FR","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.9,"discounted_cash":239.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SET CHECK-FLO LARGE VALVE ASSEMBLY 12FR 30CM W/DILATORS","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.2,"discounted_cash":139.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH HYDROPHILIC 6FR 21G 7X10CM K21-00022","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.7,"discounted_cash":203.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING PASSPORT BRAIDED 6.5FR 9MM 55X73CM PSS0655509","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5856.5,"discounted_cash":1464.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SUPRAPUBIC ONE STEP DRAINAGE CATH 16FR G26655","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":942.35,"discounted_cash":235.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDE VERSACROSS TRANS 63CM 45D D1 8.5F VXS0202","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRO HYDROPHILIC PRELUDE SNAP 6F 25CM PLSH-2506","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.37,"discounted_cash":174.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT MICRO INTRODUCER 7CM 21GA STERILE SR-4F21G7D-MP","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VSI MICRO INTRODUCER KIT 5F 7267V","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.09,"discounted_cash":56.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DRYSEAL FLEX INTRODUCER SHEATH 33CM X 26FR GDSF2633","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5252.83,"discounted_cash":1313.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SUPRAPUBIC LAWRENCE SUPRA-FOLEY 16F SF-S16-851","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.12,"discounted_cash":52.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ACCESS NAVIGATOR URETERAL 11-13FR 46mm M0062502230","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1156.28,"discounted_cash":289.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH PROXIS ACCESS 12/14F 45CM 231245","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH HI FLEX ANSEL1 12FX45CM STR FLEXOR CKFLO .035 - COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.1,"discounted_cash":172.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH FLEXOR ANSEL1 6FX45CM .018-.038 CKFLO INTRO-COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.9,"discounted_cash":136.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCESS MICROPUNCTURE PEDAL ACCESS SET - COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTRO PERCUTANEOUS SHEATH 9FR 10CM CDC-29903-X1A","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.5,"discounted_cash":321.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH FLEXOR CKFLO 12FX45CM ANSEL 1 .035-COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.1,"discounted_cash":172.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ULTIMUM 6F ACT 12CM INTRODUCER .038 ST JUDE","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":24.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COAXIAL INTRODUCER 4FX10CM ECHO TIP NEEDLE-MERIT MAK401N-E","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.23,"discounted_cash":48.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ACCESS NAVIGATOR URETERAL 11-13FR 36cm M0062502220","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1156.28,"discounted_cash":289.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DILATOR AMPLATZ SET 6-30FR 20-30L 16CM #G57459","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3202.27,"discounted_cash":800.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCESS BARIATRIC MICROPUNCTR NEEDLE21GX12CM 4FX15CM-COMED","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.69,"discounted_cash":164.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SET MICROPUNCTURE     MPIS-401-NT-SST","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.3,"discounted_cash":79.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER MICRO SET 7F X 7CM   MIS-7F07","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":51.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FLEXOR URETERAL ACCESS SHEATH FUS120045 G46168","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2050.73,"discounted_cash":512.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER ENDOVASCULAR SHEATH BRITE TIP 6FR 5.5CM 401-605M","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.25,"discounted_cash":45.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH URETERAL ACCESS FLEXOR 12FR 35CM FUS-120035","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1697.23,"discounted_cash":424.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ANSEL CHECK-FLO INTRO. 7F X 45CM .018/.038-COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.8,"discounted_cash":144.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER RADIAL ARTERY SET 20GA X 1 3/4","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.79,"discounted_cash":25.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH URETERAL ACCESS FLEXOR 12FR 28CM G19172","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1697.23,"discounted_cash":424.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER CATHETER SHEATH AVANTI+ 8FR 11CM W/WIRE 504-608X","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.86,"discounted_cash":20.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ENDOSCOPIC CLEANING ENDO-SCRUB 45D 4MM 1912013","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.06,"discounted_cash":147.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TROCAR ENDOPATH EXCEL 5MMX100MM 2CB5LT","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.29,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH FLEXOR ANSEL 6FX55CM .035 COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.1,"discounted_cash":172.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HIGH FLEX ANSEL 6FRX70CM MULTIPURPOSE - COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.9,"discounted_cash":187.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HIGH FLEX ANSEL 7FRX70CM MULTIPURPOSE - COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.9,"discounted_cash":187.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PRELUDE SNAP SPLITTABLE SHEATH 6F X 13CM PLS-1006","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.81,"discounted_cash":85.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH PROXIS ACCESS 10/12FR 35CM 231035","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH PROXIS ACCESS 10/12FR 45CM 231045","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC INFUSION SILTEX INTRAVENOUS WING SET 21GA 1 3/4IN 7B3050","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH SNAP HYDROPHILIC WING GREEN 6FR 13CM 460734","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.03,"discounted_cash":159.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH TIBIAL SUPRAPATELLAR 0642-000","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH BRITE TIP 5FR 5.5CM SRA0035","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.11,"discounted_cash":142.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET INTRODUCER SIMPLICITY MICROPUNCTURE 4FR MP-04450-AS","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.2,"discounted_cash":164.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH NANO ELBOW NEEDLE HIGH FLOW 125MM AR-3210-0053","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2049.7,"discounted_cash":512.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ULTIMUM 8F X 23CM-ST JUDE/DIAG DIVISION","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.1,"discounted_cash":69.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER 16FR G28322","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":947.6,"discounted_cash":236.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER ACCUSTICK II SS J TIP M001207100","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.6,"discounted_cash":211.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDESHEATH RADIAL SLENDER 7FR X 10CM  60-1075","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.2,"discounted_cash":242.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH 7FX10CM MINI GUIDEWIRE & DILATOR - TERUMO","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.77,"discounted_cash":28.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC SAFESHEATH II 6FR 13CM SS6","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RADIAL GLIDESHEATH SLENDER 6FX10CM ID2.0MM .021 - TERUMO","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.63,"discounted_cash":241.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ANSEL 2 6F X 45CM - COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.9,"discounted_cash":136.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HIGH FLEX ANSEL 10FRX45CM STRAIGHT - COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.1,"discounted_cash":172.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HIGH FLEX ANSEL 8FRX55CM STRAIGHT - COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.1,"discounted_cash":172.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH PROXIS ACCESS 10/14F 35CM 231235","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH FLEXOR SHUTTLE TUOHY INTRODUCR4FRX110CM.018/.035-COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.9,"discounted_cash":239.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING VERSACROSS TRANSSEPTAL DILATOR LARGE CURVE D1 45D 8.5FR 63X180CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET INTRODUCER SHEATH PERCUTANEOUS 8FR 24CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.4,"discounted_cash":149.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER BREAST BIOPSY SERTERA 14GA SERTERA INTRO-14","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.6,"discounted_cash":30.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER BREAST BIOPSY SERTERA 12GA INTRO-12","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.6,"discounted_cash":30.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEALTH 135 D OD10.06FR STERILE LF DISP DS2C027","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTRODUCER ELEMENT 17FR 13CM ELMNT17F13","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":18285.95,"discounted_cash":4571.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH ULTIMUM 16FR .035IN 35CM 407688","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":180.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH BRITE TIP 8FR 5.5CM 35MM 401805M","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.25,"discounted_cash":45.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH FAST-CATH 7FR 5CM .038IN 406168","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.99,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH ULTIMUM 7FR 23X50CM 407857","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.1,"discounted_cash":69.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TIP STRAIGHT SI BRITE 7FR 35CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.9,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER ENDOVASCULAR SHEATH  BRITE TIP 7FR 5.5cm#401-705M","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.25,"discounted_cash":45.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH BRITE TIP 6F X 35CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.9,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTRODUCER SHEATH AVEIR HYDROPHILIC COATED 25FR 8.9MM 50CM LSN25501","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":1351.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTRODUCER MICRO GALT 5FR KIT-039-04","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.32,"discounted_cash":111.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH ULTIMUM 9FR .035IN 23X50CM 407861","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.1,"discounted_cash":69.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATH INTRODUCER 7FR PERC SHEATH KIT","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.17,"discounted_cash":87.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCESS MICROPUNCTURE 5FX10CM STIFF SS GW .018X40CM COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.7,"discounted_cash":100.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET BREAST BIOPSY STD 9 GA INTRODUCER LOCALIZATION ATEC 20MM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1442.0,"discounted_cash":360.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCESS MICROPUNCTURE SILHOUETTE SET 5FR 21GA .018IN G36333","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.2,"discounted_cash":61.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ULTIMUM 7F X 23CM-ST JUDE/DIAG DIVISION","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.1,"discounted_cash":69.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ULTIMUM 7F X 12CM-ST JUDE/DIAG DIVISION","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":24.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH ULTIMUM 5F X 12CM-ST JUDE/DIAG DIVISION","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.82,"discounted_cash":24.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH FAST-CATH 10F 12CM 406120","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.86,"discounted_cash":41.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH FLEXOR CKFLO ANSEL2 7FX45CM.018/.038-COOK","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.8,"discounted_cash":144.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDESHEATH SLENDER NITI KIT .021 GW 5FRX10CM 50-1050","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH 6FX10CM MINI GUIDEWIRE & DILATOR - TERUMO","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.97,"discounted_cash":25.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER KIT 5F PICC INSERTION","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.77,"discounted_cash":64.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH FLEXOR CHECK-FLO LARGE VALVE 12FR 40CM 0.038IN G32373","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":172.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH BRITE TIP 20FR 23CM 401023M","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.9,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH FAST-CATH TRANSSEPTAL HEMOSTASIS 10F 23CM 406125","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDESHEATH SLENDER NITINOL INTRODUCER KIT 5FR 10CM 50-1050","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.9,"discounted_cash":187.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER ENDOVASCULAR SHEATH  BRITE TIP 8FR 35CM 401-835M","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.9,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPELLA COMPANION SHEATH 7FR SINGLE ACCESS 1000440","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER DRYSEAL FLEX HYDROPHILIC 16FR 6.1X33CM GDSF1633","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4542.3,"discounted_cash":1135.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER ASAHI FUBUKI SLIP-COAT 5FR 15X80CM WAIN-FBK-5SD80","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER ENDOVASCULAR SHEATH  BRITE TIP 8FR 55CM 401-855M","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.2,"discounted_cash":61.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER DRYSEAL FLEX HYDROPHILIC 12FR 4.7X33CM GDSF1233","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4542.3,"discounted_cash":1135.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTRODUCER ELEMENT 17FR 65CM ELMNT17F65","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":8919.9,"discounted_cash":2229.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER CHECK-FLO LARGE 16FR 35CM #G27023","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":947.6,"discounted_cash":236.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING R2P SLENDER DISP 75CM X 6FR GS-R6ST1C75W","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2657.4,"discounted_cash":664.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER VIZIGO LARGE CURVE 50MM 71CM D138503","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":8829.8,"discounted_cash":2207.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING DESTINO BRAIDED 8.5F 17MM 55X73CM PSS0855517","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5856.5,"discounted_cash":1464.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTRODUCER FUBUKI STRAIGHT TIP 6FR 5X90CM WAIN-FBK-6SD","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTRODUCER IMPELLA SHORT 14FR 0052-0038","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":6307.0,"discounted_cash":1576.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER ASAHI FUBUKI SLIP-COAT 4FR 15X80CM WAIN-FBK-4SD80","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER ASAHI FUBUKI SLIP-COAT 4FR 15X90CM WAIN-FBK-4SD","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT MICROINTRODUCER VSI X-SHARP STIFFIN 5FR 7X40CM 7267X","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.09,"discounted_cash":56.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH PINNACLE 11FR 2.5X25CM RSS106","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.65,"discounted_cash":44.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLIDESHEATH SLENDER NITINOL INTRODUCER KIT 6FR 10CM 50-1060","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3759.5,"discounted_cash":939.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER FARADRIVE STEERABLE (CLEAR) 13FR 74CM M004PF21M402","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":11713.0,"discounted_cash":2928.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET INTRODUCER ARROWFLEX 7FR CL-07724","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.1,"discounted_cash":146.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER MERIT S-MAK MINI ACCESS KIT 5FR 21GA .018IN 10X7CM S-MAK501N","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.84,"discounted_cash":72.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH OPTISEAL PTFE PEELABLE SMOOTH 11FR 25CM 1003975-013","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.4,"discounted_cash":149.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER MINI ACCESS KIT S-MAK 4F 21GA S-MAK401","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2549.25,"discounted_cash":637.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH FAST-CATH TRANSSEPTAL HEMOSTASIS 11FR 30CM 406182","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.58,"discounted_cash":73.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCESS LIVERTY SHORT DILATOR CATHETER NEEDLE SHEATH KIT 306466","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING VERSACROSS TRANSSEPTAL DILATOR LARGE CURVE D1 45D 8.5FR 63X180CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING PINNACLE 10FR .035IN 2.5X10CM","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.97,"discounted_cash":27.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER FARADRIVE STEERABLE (CLEAR) 13FR 74CM M004PF21M402","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":11713.0,"discounted_cash":2928.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH BRITE TIP 11CM X 45MM 10FR 401-011M","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.25,"discounted_cash":225.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER ASAHI FUBUKI SLIP-COAT STRAIGHT LONG 5FR 90CM WAIN-FBK-5SD","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING FLEXOR CHECK-FLO ALN0 CURVE 6FR 70CM G56221","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.8,"discounted_cash":239.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH GUIDING FLEXOR CHECK-FLO INTRODUCER 7FR 70CM G56222","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.8,"discounted_cash":239.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH SPARE NEEDLE NERVE STIMULATOR ENTRADA 11CM SC-4220-S45","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.5,"discounted_cash":270.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT INTRODUCER ELEMENT 17FR 33CM ELMNT17F33","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":8784.75,"discounted_cash":2196.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH FAST-CATH LARGE LUMEN HEMOSTASIS 11FR .038IN 12X50CM 406124","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.6,"discounted_cash":417.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER BRITE TIP 11CMX9FR 401911M","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.25,"discounted_cash":225.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTRODUCER SHEATH BRITE TIP 11FR 23CM 401123M","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.9,"discounted_cash":59.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEATH INTRODUCER DRYSEAL FLEX 15FR 5.6MM 33CM GDSF1533","code_information":[{"code":"27201894","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4820.4,"discounted_cash":1205.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE BIOROBOTICS AQUABEAM PROBE WATERJET  HP2000","code_information":[{"code":"27202596","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2596","type":"HCPCS"}],"standard_charges":[{"gross_charge":28374.3,"discounted_cash":7093.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":27801.28,"discounted_cash":6950.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HANDPIECE SURGICAL HYDRODISSECTION BIOROBOTICS HH1000","code_information":[{"code":"27202596","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2596","type":"HCPCS"}],"standard_charges":[{"gross_charge":29713.5,"discounted_cash":7428.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE CRYOABLATION ICEFORCE 90 DEG 2.1X17.5CM FPRPR3602","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":17073.95,"discounted_cash":4268.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRYOPROBE FLX 1.1X1150 W/OVRSHTH 20402-401","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":4822.46,"discounted_cash":1205.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE CRYOSPHERE MAX 10IN BALL 11MM A001449","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":23436.0,"discounted_cash":5859.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRYOSURGICAL TRUFREEZE CRYODECOMPRESSION TUBE 16FR 2000181","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRYOPROBE FLEXIBLE 2.4X1150 20402-411","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":3131.2,"discounted_cash":782.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CRYOPROBE FLEXIBLE 1.7X1150 20402-410","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":3475.22,"discounted_cash":868.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PROBE CYROSPHERE MAX 10IN BALL 17IN A001450SB","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":24273.0,"discounted_cash":6068.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RAPID AV TRUFREEZE CATHETER 16FR 2000516","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":16172.95,"discounted_cash":4043.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE CRYO ICEPEARL 90 DEG 2.1X175MM FPRPR3601","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":17073.95,"discounted_cash":4268.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE CRYOABLATION ICEFORCE STRAIGHT 2.1MM CX 14GA 17.5CM FPRPR3604","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":17073.95,"discounted_cash":4268.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEEDLE CRYOABLATION ICESPHERE 90 DEG 1.5X175MM FPRPR3573","code_information":[{"code":"27202618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":17073.95,"discounted_cash":4268.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON ADMIRAL 6X40X130 DRUG COATED","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":13082.52,"discounted_cash":3270.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADMIRAL DRUG COATED BALLOON CATHETER 5X120X130- COVIDIEN","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":13082.52,"discounted_cash":3270.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER PTA DRG COAT BALLOON LUTONIX 6X6 LX3575660V","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":14830.46,"discounted_cash":3707.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER PTA DRG COAT BALLOON LUTONIX 8X6X75 LX3575860V","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON ADMIRAL 4X60X130 DRUG COATED","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":13082.52,"discounted_cash":3270.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON ADMIRAL 5X60X130 DRUG COATED","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":13082.52,"discounted_cash":3270.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON ADMIRAL 7X60X130 DRUG COATED","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":13082.52,"discounted_cash":3270.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON ADMIRAL 6X150X130 DRUG COATED","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":16614.44,"discounted_cash":4153.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON ADMIRAL 7X80X130 DRUG COATED","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":13082.52,"discounted_cash":3270.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PTA BALLOON ADMIRAL 6X60X130 DRUG COATED","code_information":[{"code":"27202623","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":13082.52,"discounted_cash":3270.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER BONANNO SUPRAPUBIC  408289","code_information":[{"code":"27202627","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2627","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.78,"discounted_cash":194.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SUPRAPUBIC 16F 2- STAGGER EYES PVC #551316","code_information":[{"code":"27202627","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2627","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.84,"discounted_cash":98.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER SUPRAPUBIC STAMEY 14FR 30CM G55824 (REPLACED ECH#001642).","code_information":[{"code":"27202627","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2627","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.30,"discounted_cash":135.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET SUPRAPUBIC MALECOT DRAINAGE 12FR 30CM G55823","code_information":[{"code":"27202627","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2627","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.59,"discounted_cash":193.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HSG TRAY WITH 5FR CATHETER","code_information":[{"code":"27202628","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.58,"discounted_cash":125.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COOK CATHETER BALLOON 9FR DILATATION CODA LOW PROFILE G03831","code_information":[{"code":"27202628","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":5658.28,"discounted_cash":1414.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER OCCLUSION RELIANT STENT GRAFT 100CM 10-46MM REL46","code_information":[{"code":"27202628","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":4470.2,"discounted_cash":1117.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GUIDE CATHETER BOBBY BALLOON 8FR 95CM BOB-895","code_information":[{"code":"27202628","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":15767.5,"discounted_cash":3941.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BRIDGE OCCLUSION BALLOON 80MM 590-001","code_information":[{"code":"27202628","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":8604.55,"discounted_cash":2151.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MOLDING OCCLUSION BALLOON CATH 10-37mm 90CM 10FR MOB37","code_information":[{"code":"27202628","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER ABLATION TACTIFLEX DF Bi-D IRRIGATED A-TFSE-DF","code_information":[{"code":"27202630","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":33480.0,"discounted_cash":8370.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 3.0X30MM H7493960830300","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 3.00 X 15MM H7493960815300","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 3.00 X 12MM H7493960812300","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 4.00 X 15MM H7493960815400","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 3.50 X 30MM H7493960830350","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 2.50 X 30MM H7493960830250","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 4.00 X 20MM H7493960820400","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 3.50 X 20MM H7493960820350","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 3.00 X 20MM H7493960820300","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 2.50 X 20MM H7493960820250","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON AGENT US MR DCB 2.50 X 12MM H7493960812250","code_information":[{"code":"27209610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C9610","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CERVICAL COLLAR MED","code_information":[{"code":"27400120","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.54,"discounted_cash":6.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLLAR CERVICAL FORM FIT SM/LONG 79-83014","code_information":[{"code":"27400120","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.54,"discounted_cash":6.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLLAR ASPEN CHILD REGULAR 13-16IN","code_information":[{"code":"27400172","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLLAR ASPEN ADULT TALL  3.75IN","code_information":[{"code":"27400172","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLLAR ASPEN CHILD TODDLER 1-3 YEARS","code_information":[{"code":"27400172","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLLAR ASPEN ADULT SHORT 2.25IN","code_information":[{"code":"27400172","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLLAR ASPEN ADULT REGULAR 3IN","code_information":[{"code":"27400172","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":208.32,"discounted_cash":52.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPLINT KNEE 20\" LENGTH UNIVERAL THIGH","code_information":[{"code":"27401830","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.22,"discounted_cash":26.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPLINT KNEE 24\" LENGTH UNIVERSAL THIGH","code_information":[{"code":"27401830","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.79,"discounted_cash":28.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPLINT KNEE 26\" LENGTH UNIVERSAL THIGH","code_information":[{"code":"27401830","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.61,"discounted_cash":40.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMMOBILIZER KNEE DELUXE CONTOURED SMALL #79-80023","code_information":[{"code":"27401830","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.23,"discounted_cash":18.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMMOBILIZER ORTHO UNIVERSAL KNEE","code_information":[{"code":"27401830","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.48,"discounted_cash":211.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMMOBILIZER SHOULDER LARGE","code_information":[{"code":"27403650","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.67,"discounted_cash":9.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMMOBILIZER SHOULDER MEDIUM #79-84015","code_information":[{"code":"27403650","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.67,"discounted_cash":9.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMMOBILIZER SHOULDER SMALL","code_information":[{"code":"27403650","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.67,"discounted_cash":9.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SLING ARM ULTRASLING III LARGE BLACK 11-0449-4","code_information":[{"code":"27403670","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.71,"discounted_cash":105.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMMOBILIZER SHOULDER X-LARGE","code_information":[{"code":"27403670","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.67,"discounted_cash":9.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TRACH & VENT SWALLOW SPEAK VALVE PURPLE OD23MM ID15MM PMV2001-D","code_information":[{"code":"27408501","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.08,"discounted_cash":189.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIBRILLATOR CARDIAC RIVACOR PROMRI DF4 7 DRT 429534","code_information":[{"code":"27501721","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":101400.0,"discounted_cash":25350.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEBIB COBALT XT MRI QUAD CRT-D DF-4 DTPA2QQ","code_information":[{"code":"27501722","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":137680.92,"discounted_cash":34420.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIB COBALT ST MRI VR SINGLE CHAMBER DF-4 DVPA2D4","code_information":[{"code":"27501722","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":91787.28,"discounted_cash":22946.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIB COBALT ST MRI VR SINGLE CHAMBER DF-1 DVPA2D1","code_information":[{"code":"27501722","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":91787.28,"discounted_cash":22946.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIB COBALT XT MRI DR DUAL CHAMBER DF-4 DDPA2D4","code_information":[{"code":"27501722","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":99737.04,"discounted_cash":24934.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIB COBALT XT MRI DR DUAL CHAMBER DF-1 DDPA2D1","code_information":[{"code":"27501722","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":99737.04,"discounted_cash":24934.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIBRILLATOR EMBLEM MRI S-ICD A219","code_information":[{"code":"27501722","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":131820.0,"discounted_cash":32955.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIB COBALT XT MRI CRT-D DF-4 DTPA2D4","code_information":[{"code":"27501722","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":134273.88,"discounted_cash":33568.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DUAL CHAMBER AMVIA EDGE DR-T 460163","code_information":[{"code":"27501785","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33396.3,"discounted_cash":8349.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER ASSURITY MRI THK PM2272","code_information":[{"code":"27501785","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":32207.76,"discounted_cash":8051.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACEMAKER ACCOLADE MRI DR IS-1 L311","code_information":[{"code":"27501785","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":36828.0,"discounted_cash":9207.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACEMAKER AZURE MRI XT DR DUAL CHAMBER W1DR01","code_information":[{"code":"27501785","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":33480.0,"discounted_cash":8370.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICRA AV2 PACING CAPSULE AND DELIVERY CATHETER MC2AVR1","code_information":[{"code":"27501786","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":96127.2,"discounted_cash":24031.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MICRA VR2 PACING CAPSULE AND DELIVERY CATHETER MC2VR01","code_information":[{"code":"27501786","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":73075.6,"discounted_cash":18268.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACEMAKER AZURE MRI XT SR SINGLE CHAMBER W1SR01","code_information":[{"code":"27501786","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":28257.12,"discounted_cash":7064.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOTRONIK PACEMAKER AMVIA EDGE SR-T PRO MRI 460164","code_information":[{"code":"27501786","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":30759.75,"discounted_cash":7689.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACEMAKER CARDIAC AVEIRAR2 LEADLESS LSP203A","code_information":[{"code":"27501786","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":85514.0,"discounted_cash":21378.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIBRILLATOR GALLANT HF 12X51X74MM 36CC 76GM CDHFA500Q","code_information":[{"code":"27501882","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":145657.72,"discounted_cash":36414.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIBRILLATOR CARDIAC RIVACOR PROMRI 7 HF-T QP 429532","code_information":[{"code":"27501882","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":128440.0,"discounted_cash":32110.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEFIB CARDIAC VIGILANT X4 CRT-D .99X5.37X8.18CM G247","code_information":[{"code":"27501882","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":153681.84,"discounted_cash":38420.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE LEAD PACING W/ALLIGATOR CLIP 301-CG 6FT 343586","code_information":[{"code":"27501883","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1883","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.9,"discounted_cash":114.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE NEUROSTIMULATOR PERCUTANEOS LEAD 9009","code_information":[{"code":"27501883","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1883","type":"HCPCS"}],"standard_charges":[{"gross_charge":7739.59,"discounted_cash":1934.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LEAD EPICARDIAL BIPOLAR SCREW-IN 511212","code_information":[{"code":"27501898","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3914.0,"discounted_cash":978.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACING LEAD BIPOLAR MYOCARDIAL TEMP 6495F","code_information":[{"code":"27501898","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.37,"discounted_cash":117.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LEAD CAPSUREFIX NOVUS SCREW IN STR ATRIUM VENTRICULAR 45CM","code_information":[{"code":"27501898","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.1,"discounted_cash":1048.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LEAD PACEMAKER ST JUDE TENDRIL STS 52CM 2088TC/52","code_information":[{"code":"27501898","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":5180.75,"discounted_cash":1295.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LEAD CAPSUREFIX NOVUS STR VENTRICULAR 52CM - 5076-52","code_information":[{"code":"27501898","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":4192.1,"discounted_cash":1048.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LEAD PACEMAKER ST JUDE TENDRIL STS 58CM 2088TC/58","code_information":[{"code":"27501898","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":5180.75,"discounted_cash":1295.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ATTAIN STABILITY MRI SURESCAN LV LEAD 4798-78CM 479878","code_information":[{"code":"27501900","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":19125.45,"discounted_cash":4781.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER PERCEPTA QUAD CRTP MRI US W4TR01","code_information":[{"code":"27502621","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":50756.52,"discounted_cash":12689.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PACER PERCEPTA CRTP MRI US W1TR01","code_information":[{"code":"27502621","type":"CDM"},{"code":"0275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":50756.52,"discounted_cash":12689.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 19.5 DIOPTER CNA0T0-19.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 20.0 DIOPTER CNA0T0-20.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 27.0 DIOPTER CNA0T0-27.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 30.0 DIOPTER CNA0T0-30.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 20.5 DIOPTER CNA0T0-20.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 23.5 DIOPTER CNA0T0-23.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 22.0 DIOPTER CNA0T0-22.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 18.5 DIOPTER CNA0T0-18.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 24.0 DIOPTER CNA0T0-24.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON PANOPTIX 22.0D CNWTT0.220","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9145.15,"discounted_cash":2286.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 21.5 DIOPTER CNA0T0-21.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 17.5 DIOPTER CNA0T0-17.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 15.5 DIOPTER CNA0T0-15.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 16.5 DIOPTER CNA0T0-16.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC ASPHERIC ACRYLIC 12.0D CNW0T4.12.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 11.0 DIOPTER CNA0T0-11.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 14.5 DIOPTER CNA0T0-14.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 14.0 DIOPTER CNA0T0-14.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 13.5 DIOPTER CNA0T0-13.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE +24.0D DIB00 24.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE +25.0D DIB00 25.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 23.0 DIOPTER CNA0T0-23.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 22.5 DIOPTER CNA0T0-22.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 21.0 DIOPTER CNA0T0-21.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE 22.5D DIB00-22.5","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL MULTIPIECE POSTERIOR CHAMBER 5.0D MA60MA+5.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.2,"discounted_cash":319.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON 17.0 DIOPTER CNA0T0-17.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL MULTIPIECE POSTERIOR CHAMBER +2.0D MA60MA.020","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.2,"discounted_cash":319.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +11.5D CNW0T7.115","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS EYHANCE +15.5D DIB00U0155","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +21.5D CNA0T4.215","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5067.6,"discounted_cash":1266.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON PANOPTIX PRO +20.0D PXYAT0.200","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9595.65,"discounted_cash":2398.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL ACRYSOF MULTIPIECE POSTERIOR 7.0D MA60AC.070","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.2,"discounted_cash":319.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON PANOPTIX PRO +21.5D PXYAT0.215","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9595.65,"discounted_cash":2398.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON PANOPTIX PRO +19.5D PXYAT0.195","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9595.65,"discounted_cash":2398.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON STABLEFORCE HYDROPHOBIC TORIC +16.5D CCA0T3.165","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5067.6,"discounted_cash":1266.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON +13.5D SY60WF.135","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +14.0D CNA0T4.140","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5067.6,"discounted_cash":1266.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON PANOPTIX PRO +22.0D PXYAT0.220","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9595.65,"discounted_cash":2398.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +18.5D CNA0T4.185","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5067.6,"discounted_cash":1266.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL ACRYSOF MULTIPIECE POSTERIOR +10.0D MA60AC.100","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.2,"discounted_cash":319.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +19.5D CNA0T4.195","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5067.6,"discounted_cash":1266.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TEC ODYSSEY TORIC II +11.0D DRT1500110","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":8964.95,"discounted_cash":2241.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC AUTONOME +15.0D CNA0T5.150","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5067.6,"discounted_cash":1266.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON PANOPTIX PRO +17.0D PXYAT0.170","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9595.65,"discounted_cash":2398.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL AUTONOME CLAREON +9.0D CNA0T0.090","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +17.5D CNW0T3.175","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CYL EYHANCE TORIC +20.5D DIU150U205","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5360.95,"discounted_cash":1340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON PANOPTIX +22.5D CNWTT0.225","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9145.15,"discounted_cash":2286.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +23.5D CNW0T3.235","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +13.0D CNW0T3.130","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +20.5D CNW0T3.205","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +18.0D CNW0T4.180","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC 12.0D CNW0T7+12.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +14.0D CNW0T9.140","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC +21.0D CNW0T4.210","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON PANOPTIX +20.0D CNWTT0.200","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9145.15,"discounted_cash":2286.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC 8.0D CNW0T3.080","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL MULTIPIECE POSTERIOR 17.0D MA60AC.170","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.2,"discounted_cash":319.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON PANOPTIX PRO +20.0D PXYAT3.200","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9595.65,"discounted_cash":2398.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS EYHANCE +23.0D DIB00U0230","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ACRYLIC POSTERIOR 20.5 DIOPTER ZCB0020.5","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECHNIS ACRYLIC POSTERIOR 21.0 DIOPTER ZCB0021.0","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DELIVERY SYSTEM W/LENS 16.0D DCB0016.0","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS EYHANCE 19.5D DIB00 19.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IOL ABBOTT TECNIS 19.5 DIOPTER ZA9003-19.5","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON HYDROPHOBIC 25.5D CC60WF25.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON HYDROPHOBIC 20.5D CC60WF20.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON HYDROPHOBIC 20.0D CC60WF20.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IOL ABBOTT TECNIS 19.0 DIOPTER ZA9003-19.0","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON 22.0D CC60WF22.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON 19.5D CC60WF19.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IOL ABBOTT TECNIS 21.5 DIOPTER ZA9003-21.5","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC 21.5D SY60WF21.5","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC 22.0 SY60WF 22.0","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON ASPHERIC HYDROPHOBIC ACRYLIC 20.0 SY60WF 20.0","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON +20.5D SY60WF.205","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL INTRAOCULAR CLAREON +18.5D SY60WF.185","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON +23.5D SY60WF.235","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON +17.0D SY60WF.170","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON HYDROPHOBIC 26.0D CC60WF.260","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS EYHANCE +16.0D DIB00U0160","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CYL EYHANCE TORIC 23.0D DIU225U230","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5360.95,"discounted_cash":1340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL RXSIGHT LIGHT ADJUSTABLE +11.0D 60007-0110","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9010.0,"discounted_cash":2252.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS OPTIEDGE +20.0D ZA90030200","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.7,"discounted_cash":383.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ODYSSEY 22.0D DRN00V0220","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":8964.95,"discounted_cash":2241.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ODYSSEY 21.5D DRN00V0215","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC 23.0D CNW0T8.230","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CYL EYHANCE TORIC 21.5D DIU225U215","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5360.95,"discounted_cash":1340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CYL EYHANCE TORIC +22.0D DIU150U220","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":5360.95,"discounted_cash":1340.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON VIVITY +22.5D CNWET0.225","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9145.15,"discounted_cash":2286.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL INTRAOCULAR CLAREON +21.0D SY60WF.210","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IOL UV CLAREON +14.5D CC60WF.145","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL ACRYSOF MULTIPIECE POSTERIOR +11.0D MA60AC.110","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.2,"discounted_cash":319.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ODYSDDEY +23.5D DRN00V0235","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":8964.95,"discounted_cash":2241.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ODYSSDEY +25.0D DRN00V0250","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":8964.95,"discounted_cash":2241.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON +15.0D CC60WF.150","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ODYSSEY 21.0D DRN00V0210","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":386.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECHNIS ACRYLIC POSTERIOR +8.0D ZCB0000080","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON 14.0D CC60WF.140","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON +17.5D CC60WF.175","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS TECNIS SIMPLICITY CLR MONO DCB00+9.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON VIVITY +24.0D CNWET0.240","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":9145.15,"discounted_cash":2286.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON HYDROPHOBIC ACRYLIC +19.0D SY60WF19.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON HYDROPHOBIC 18.0D CC60WF18.0","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL MULTIPIECE POSTERIOR 20.5D MA60AC20.5","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.2,"discounted_cash":319.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON ASPHERI HYDROPHOBIC ACRYLIC +18.0D SY60WF18.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON +20.0D SY60WF.200","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL UV CLAREON HYDROPHOBIC +23.5D CC60WF+23.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON +22.5D SY60WF.225","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON TORIC 17.5D CNW0T6.17.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":4964.6,"discounted_cash":1241.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE +18.5D DIB00 18.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS EYHANCE 19.0D DIB00 19.D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL CLAREON MONOFOCAL BLF 9.5D SY60WF9.5","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE +17.5D DIB00 17.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE +21.0D DIB00 +21.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL INTRAOCULAR CLAREON 19.5D SY60WF.195","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE +22.0D DIB00 22.0D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE 24.5D DIB00 24.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL INTRAOCULAR CLAREON +24.0D SY60WF.240","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE +21.5D DIB00 21.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS INTRAOCULAR CLAREON 23.0D SY60WF.230","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.2,"discounted_cash":345.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LENS IOL TECNIS ENHANCE +23.5D DIB00 23.5D","code_information":[{"code":"27602632","type":"CDM"},{"code":"0276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE AORTIC INSPIRIS RESILIA 21MM 11500A21","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":70092.0,"discounted_cash":17523.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE AORTIC INSPIRIS RESILIA 23MM 11500A","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":70092.0,"discounted_cash":17523.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MESH EPIFIX HUMAN AMNION 4 X 4.5 ES-4400","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":13469.95,"discounted_cash":3367.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRAVIX PLACENTAL TISSUE 3X6CM PS60008","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":22226.54,"discounted_cash":5556.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT PERICARDIUM DECELLURIZED BOVINE 6 X 8 PFP6x8","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8784.75,"discounted_cash":2196.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER DELTA COUPLING PIN TO ROD 5 HOLE 4922-1-020","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":7595.43,"discounted_cash":1898.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT VENTRICULAR ARES CATH ANTIBIOTIC IMPLANTABLE 95001","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":5257.34,"discounted_cash":1314.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT MTF FLEX HD STRUCTURAL COLLAGEN MATRIX 16X20MM 471620","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":58677.62,"discounted_cash":14669.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE AORTIC INSPIRIS RESILIA 25MM 11500A25","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":70092.0,"discounted_cash":17523.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER DELTA COUPLING ROD TO RODS OR 0.5MM PINS 4922-1-010","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8298.21,"discounted_cash":2074.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT VIABLE BONE MATRIX ORTHO BIO4 5CC 3102-2105","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":24858.9,"discounted_cash":6214.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE AORTIC INSPIRIS RESILIA 27MM 11500A27","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":70092.0,"discounted_cash":17523.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANCELLOUS CHIPS 4-9.5mm 30cc FREEZE DRIED 27615030","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":3795.45,"discounted_cash":948.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHIPS CANCELLOUS CRUSHED 1-4MM 5CC FRZ DRIED 27715005","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":771.68,"discounted_cash":192.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHIPS CANCELLOUS CRUSHED 1-4MM 15CC FRZ DRIED 27715015","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2250.65,"discounted_cash":562.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CHIPS CANCELLOUS CRUSHED 1-4MM 30CC FRZ DRIED 27715030","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT PERICARDIUM PHOTOFIX BOVINE 8X14 PFP8X14","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":17974.95,"discounted_cash":4493.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM EMBOLIC LAVA-18 2ML SLLES182","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":25110.0,"discounted_cash":6277.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION VORTX INTRODUCER PUSH OCCLUSION VASCULAR 18 COIL 3X3.3X23MM M0013822031","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":4489.46,"discounted_cash":1122.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC RING CONTOUR 3D 34MM 690R34","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SKIN FLEXHD PLIABLE 8X16CM PF2816","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":26267.57,"discounted_cash":6566.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE SHUNT STRATAMR II ADJUSTABLE 42955MR","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":39883.05,"discounted_cash":9970.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SOFT TISSUE AMNIOEFFECT 4X6CM LS-5460","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":21536.01,"discounted_cash":5384.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT MEMBRANE AMNIOTIC PLACENTA PRO3-P 4X8CM P01-AMP-0408","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":23582.48,"discounted_cash":5895.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEMBRANE PLACENTAL GRAFIX PL XC 5X5CM PS15055","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTEGRA MESHED BILAYER WOUND MATRIX 20CM X 25CM (8IN X10IN) MWM8101","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":108186.16,"discounted_cash":27046.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE AORTIC EVOLUT FX+ TRANSCATHETER 26MM EVFXPLUS-26","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":202800.0,"discounted_cash":50700.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE WATCHMAN FLX PRO LEFT ATRIAL APPENDAGE 35MM M635WU60350","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE AORTIC EVOLUTFX+ TRANSCATHETER 23MM EVFXPLUS-23","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":202800.0,"discounted_cash":50700.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE VENTILATION PARARELLA SILICONE MICROGEL 1.14MM 1025001","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":217.54,"discounted_cash":54.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TISSUE INTEGRA DERMAL REGENERATION TEMPLATE 4X5IN MDRT4051","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPANDER TISSUE CPX4 PLUS MEDIUM HEIGHT SMOOTH 550CC SCPX-135MH","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":16037.8,"discounted_cash":4009.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RING ANNULOPLASTY MEDTRONIC PROFILE 3D 30MM 680R30","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC RING CONTOUR 3D 30MM 690R30","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT DURAGEN MATRIX SUTURABLE 2X2IN DURS2291","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1765","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EPIFIX 2X4 8 SQ CM AMNIOTIC ALLOGRAFT  GS-5240","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":13118.56,"discounted_cash":3279.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT EPIFIX AMNION MEMBRANE 2 X 3 CM GS-5230","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":11676.96,"discounted_cash":2919.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EPIFIX 14MM 1.5 SQ CM AMNIOTIC ALLOGRAFT GS-5140","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":3656.5,"discounted_cash":914.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFIXPLTM PRIME 3 X 4 CM PS13034","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":11082.3,"discounted_cash":2770.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFIXPLTM PRIME 5 X 5 CM PS13055","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":20422.8,"discounted_cash":5105.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT DURAGEN MATRIX SUTURABLE 4X5IN DURS4591","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":14577.01,"discounted_cash":3644.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE AORTIC EVOLUTFX+ TRANSCATHETER 34MM EVFXPLUS-34","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":202800.0,"discounted_cash":50700.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CATHETER EDM VENTRICULAR W/TROCAR 46118","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1419.86,"discounted_cash":354.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC RING PROFILE 3D 32MM 680R32","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"HDE SYSTEM IBV VALVE 7MM HUS-V7","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2750.0,"discounted_cash":687.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC RING CONTOUR 3D 32MM 690R32","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL OCCLUSION VORTX-18 DIAMOND SHAPED 3X3.3MM 382203","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":897.85,"discounted_cash":224.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"APPLIER INTERNAL CLIP DAT CLIP 15MM 235CM TC35531","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":3543.2,"discounted_cash":885.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE WATCHMAN FLX PRO LEFT ATRIAL APPENDAGE 40MM M635WU60400","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE WATCHMAN FLX PRO LEFT ATRIAL APPENDAGE 31MM M635WU60310","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE WATCHMAN FLX PRO LEFT ATRIAL APPENDAGE 27MM M635WU60270","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE WATCHMAN FLX PRO LEFT ATRIAL APPENDAGE 24MM M635WU60240","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE CLOSURE WATCHMAN FLX PRO LEFT ATRIAL APPENDAGE 20MM M635WU60200","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM EMBOLIZATION ONYX 18 DIMETHYL SULFOXIDE 1.5X1ML 105-7100-060","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":23243.49,"discounted_cash":5810.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE AORTIC EVOLUTFX+ TRANSCATHETER 29MM EVFXPLUS-29","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":202800.0,"discounted_cash":50700.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC RING PROFILE 3D 36MM 680R36","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SKIN FLEXHD PLIABLE PRE ACELLULAR DERMAL MATRIX LARGE 21X24CM PP0002","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":93740.11,"discounted_cash":23435.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENT GRAFT ENDO GORE EXCLUDER AAA 12FR 10CM 16X12MM PLC121000","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38895.39,"discounted_cash":9723.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLLAGEN 100% BOVINE POROUS NUFORRA .03OZ NUF-300","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":12568.95,"discounted_cash":3142.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPANDER TISSUE ARTOURA PLUS SMOOTH 375CC SDC-120H","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MATRIX TISSUE AMNION THICK SOFT 3X4CM ABS-4200-034","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":23436.0,"discounted_cash":5859.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAGE MODULUS ALIF 10D 6X34X24MM 1921001P2","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAGE SPINAL COHERE CERVICAL 7D 6X16X14MM 4061647P2","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEOX FLO AMNIOTIC MEMBRANE MATRIX TISSUE 100MG NX-FL-100MG","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SOFT TISSUE NEOX CORT RT 6X3CM NX-UR-6030","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR BIOINDUCTIVE W/ARTHRO DELIVERY SYSTEM LARGE 4566","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":22599.0,"discounted_cash":5649.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SOFT TISSUE NEOX CORT RT 8X3CM NX-UR-8030","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":20088.0,"discounted_cash":5022.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NEOX FLO AMNIOTIC MEMBRANE MATRIX TISSUE 150 MG NX-FL-150MG","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":20925.0,"discounted_cash":5231.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPACER INTRAPOSITIONAL FLEXBAND STRIP 8X0.5CM 31053","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":12983.41,"discounted_cash":3245.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACELLULAR DERMIS GRAFT FLEXHD PLIABLE PRE 19x22CM PP1500","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":83824.0,"discounted_cash":20956.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT PUTTY NEVOS DBM MATRIX BNEP0010","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":9415.45,"discounted_cash":2353.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT NASAL PROPEL CONTOUR MOMETASONE 370MCG 50011","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8426.15,"discounted_cash":2106.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE INFUSE RHBMP-2 XS KIT LUMBAR TAPER FUSION 7510100","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":18162.9,"discounted_cash":4540.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLUG TRUE-LOCK BOUCHON 9471S","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1339.0,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MATRIX HUMAN AMNION TISSUE SOFT 3CMX8CM ABS-4200-038","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":36828.0,"discounted_cash":9207.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PORCINE FORTIVA DERMAL L10 CM X W16 CM PD1016","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":22096.8,"discounted_cash":5524.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRAVIX PLACENTAL TISSUE 2X4CM PS60005","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":15046.7,"discounted_cash":3761.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACCESSORY KIT 700 SERIES PENILE PROSTHESIS #72401850","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":7876.54,"discounted_cash":1969.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR HOLE COVER 12MM 421.525","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2349.02,"discounted_cash":587.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT DURAGEN 3 X 3","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8907.56,"discounted_cash":2226.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT DURAGEN 1 X 3","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":5035.46,"discounted_cash":1258.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT DURAGEN 1 X 1","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2842.18,"discounted_cash":710.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE TRANSGASTRIC JEJUNAL MIC 16FR ENFIT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2146.73,"discounted_cash":536.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE FEEDING 5FR X 51CM ENFIT 461412E","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":49.34,"discounted_cash":12.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SOFT TISSUE NEOX CORD RT 2X2CM NX-UR-2020","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":5856.5,"discounted_cash":1464.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXPANDER TISSUE ARTOURA PLUS SMOOTH 600CC SDC-140H","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BALLOON SPHINCTER 61-70CM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":26084.27,"discounted_cash":6521.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ALLODERM SELECT TISSUE MATRIX X-THIN 1X4CM 141404","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":3749.2,"discounted_cash":937.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAPSULAR TENSION RING MORCHER 14C MR-1420 / D-70374","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1843.7,"discounted_cash":460.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC SHUNT VENTRICULAR STRATA II REGULAR 42965MR","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":33480.0,"discounted_cash":8370.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE MEDTRONIC INFUSE KIT XXSMALL 7510050","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":9820.9,"discounted_cash":2455.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE INFUSE KIT MEDIUM 7510400","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE MEDTRONIC INFUSE KIT LARGE  7510600","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":46515.6,"discounted_cash":11628.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AMS 800 IZ ACCESSORY KIT  720066-01","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":12317.57,"discounted_cash":3079.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BURR HOLE COVER  17MM DIA 421.527","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2349.02,"discounted_cash":587.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2349.02,"discounted_cash":587.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ALLODERM SELECT TISSUE MATRIX THIN 2X4CM 141608","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":5703.33,"discounted_cash":1425.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLLAGEN 100% BOVINE POROUS NUFORRA .03OZ NUF-300","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":12568.95,"discounted_cash":3142.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER BONE CEMENT SIMPLEX TOBRA 40GM CS/10 6197-9-010","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":669.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC EXTENSION EXTENDER TIP PENILE NARROW REAR 519300","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTEGRA GRAFT DURAGEN CRANIAL PATCH 1 X 1IN ID-1101","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":3462.55,"discounted_cash":865.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MTF FLEXIBLE HD PLIABLE MESH SHEET 4 X 12CM HP1412","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":10629.28,"discounted_cash":2657.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE CHIPS 30CC CANCELLOUS T00040","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3460.8,"discounted_cash":865.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE CHIPS 30CC CANCELLOUS T00040","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":3460.8,"discounted_cash":865.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT BONE CRUSHED CORTICAL CANCEL 0.5-3MM 15CC T00060","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2002.32,"discounted_cash":500.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT BONE CRUSHED CORTICAL CANCEL 0.5-3MM 15CC T00060","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2002.32,"discounted_cash":500.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MEDTRONIC CORTICAL CANCELLOUS CRUSHED 0.5-3MM 30CC T00070","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":3343.38,"discounted_cash":835.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SOFT TISSUE RESTORIGIN AMNION PATCH MEDIUM 4X6CM RSX-AC-0406","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":22431.6,"discounted_cash":5607.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SOFT TISSUE DERMIS DECELLULARIZED 2X40X70MM AFLEX201","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":24900.75,"discounted_cash":6225.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MATRIX TISSUE GRAFTJACKET NOW THIN 4X4CM 86104X04","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":18949.68,"discounted_cash":4737.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT TISSUE RESTORIGIN MATRIX AMNION PATCH MEDIUM 2X3CM RSX-AC-0203","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8063.95,"discounted_cash":2015.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SKIN FLEXHD PLIABLE PRE ACELLULAR DERMAL MATRIX THICK SMALL 22X19CM PP1502","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":83824.0,"discounted_cash":20956.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SKIN FLEXHD PLIABLE PRE ACELLULAR DERMAL MATRIX THICK MEDIUM 21X24CM PP2002","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":93740.11,"discounted_cash":23435.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC AMS PROSTHESIS PENILE REAR TIP EXTENDER SNAP 2CM 72404322","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADHERUS AUTOSPRAY DURAL SEALANT W/EXT TIP 6ML NUS-109","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":7960.34,"discounted_cash":1990.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION AZUR CX HYDROGEL POROUS DETACHABLE SOFT SOLID .035IN 13MM 24CM 45-751324","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":10343.48,"discounted_cash":2585.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION AZUR CX HYDROGEL POROUS DETACHABLE CROSS SECTIONAL .035IN 20MM 39CM 45-752039","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":10343.48,"discounted_cash":2585.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER BONE CEMENT SIMPLEX TOBRA 40GM CS/10 6197-9-010","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":669.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENFIT MICKEY LOW PROFILE JEJUNAL TUBE 14FR 4.0CM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1637.8,"discounted_cash":409.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RESTICTOR CEMENT 24MM EBO101","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1141.76,"discounted_cash":285.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFIX XC CRYOPRESERVED 7.5X15CM PLACENTAL MEMBRANE PS24075","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":55372.68,"discounted_cash":13843.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION TARGET 1.5MM X 3CM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":18824.97,"discounted_cash":4706.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHERE EMBOLIZATION GREEN EMBOGOLD 700-900UM GELATIN 2% S820EG","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHERE EMBOLIZATION RED EMBOGOLD 500-700UM GELATIN 2% S620EG","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION AZUR CX HYDROGEL POROUS DETACHABLE SOFT SOLID .035IN 16MM 32CM 45-751632","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":10343.48,"discounted_cash":2585.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHERE EMBOLIZATION BLUE EMBOGOLD 300-500UM GELATIN 2% S420EG","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOLIC LAVA-34 LIQUID SYSTEM 2ML SLLES342","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":25110.0,"discounted_cash":6277.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION TORNADO MICROCOIL FIBER .018IN 3-2MM G47416","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENT GRAFT ENDOVASCULAR GORE EXCLUDER ILIAC INTERNAL COMPONENT AAA 12FR 7CM 14.5X16MM HGB161407A","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":27997.65,"discounted_cash":6999.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT GORE EXCLUDER AAA EPTFE NITINOL 12FR 13.5CM 16X20MM PLC201400","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38895.39,"discounted_cash":9723.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER PLATINUM FIBER .035IN 14CM 6MM G47354","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT EXCLUDER CONFORMABLE ENDOPROSTHESIS AAA 32X14.5X14CM CXT321414","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":92267.24,"discounted_cash":23066.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ALLODERM TISSUE MATRIX TRU PERF THIN 132CM CM1516P","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPHERE EMBOLIZATION YELLOW EMBOGOLD 100-300UM GELATIN 2% S220EG","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENFIT MICKEY LOW PROFILE JEJUNAL TUBE 14FR 4.5CM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1637.8,"discounted_cash":409.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER 7CM X","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":798.46,"discounted_cash":199.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER MICROCOIL PLATINUM 3CM G47332","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":731.92,"discounted_cash":182.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER 3CM X","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":731.92,"discounted_cash":182.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER 35-14-8mm","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER  MICROCOIL 14CM PLATINUM G47352","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER 35-14-12mm","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER 35-14-10mm","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER  18-14-6 MM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER  18-14-3 MM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION MWCE TORNADO 35-7/3","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL TORNADO EMBOLIZATION  35-5/3M G47520","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION MWCE TORNADO 35-4/3","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE TRANSGASTRIC JEJUNAL MIC 22FR ENFIT 825022","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2084.21,"discounted_cash":521.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE TRANSGASTRIC JEJUNAL MIC 18FR ENFIT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2146.73,"discounted_cash":536.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOLIZATION EMBOSPHERE MICROSPHERES500-700-BIOSPHEREMEDICAL","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER 14CM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE GASTROSTOMY FEEDING MIC 18FR ENFIT 810018","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":212.59,"discounted_cash":53.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT STENT GORE TAG THORACIC ACTIVE CONTROL CONFORMABLE 10CM 28MM TGM282810","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":139972.56,"discounted_cash":34993.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENT GRAFT EXTENDER EXCLUDER CONFORMABLE ENDOPROSTHESIS AAA 4.5CM 32MM CXA320005","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":39104.64,"discounted_cash":9776.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ADAPTER PORT GIENTRI SINGLE LUMEN ENFIT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":53.05,"discounted_cash":13.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE GASTROSTOMY FEEDING MIC 20FR ENFIT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":206.41,"discounted_cash":51.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE NASOGASTRIC FEEDING 10FR 55IN ENTRIFLEX ENFIT WEIGHTED","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":92.4,"discounted_cash":23.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE NASOGASTRIC FEEDING 12FR 43IN ENTRIFLEX ENFIT WEIGHTED","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":92.39,"discounted_cash":23.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION AZUR CX HYDROGEL POROUS DETACHABLE SOFT SOLID .035IN 10MM 19CM 45-751019","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":10343.48,"discounted_cash":2585.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT ENDOVASCULAR EXCLUDER 12FR 16MM 9.5CM PLC161000","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38895.39,"discounted_cash":9723.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE JEJUNAL FEEDING 16FR ENFIT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1229.61,"discounted_cash":307.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENT GRAFT ENDOVASCULAR EXCLUDER AAA 15FR 12CM 16X27MM PLC271200","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38895.39,"discounted_cash":9723.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LEG  16MM X 23MM X 10CM  14FR PLC231000","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38895.39,"discounted_cash":9723.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLD FIBERED DETACHABLE SYSTEM 15X177CM 4MM M001394240040150","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLUG OCCLUSION AZUR NITINOL MEDIUM 8X15MM 445-180800","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENT GRAFT GORE EXCLUDER AAA ENDOPROSTHESIS 15FR 14CM 16X27MM PLC271400","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38895.39,"discounted_cash":9723.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENT GRAFT EXCLUDER CONFORMABLE ENDOPROSTHESIS AAA 16FR 12CM 26X14.5MM CXT261412","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":92267.24,"discounted_cash":23066.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXTENDER AORTIC EXCLUDER ENDOPROSTHESIS AAA 15FR 4.5CM 20MM CXA200005","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38334.6,"discounted_cash":9583.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT STENT GORE TAG THORACIC ACTIVE CONTROL CONFORMABLE 10CM 31MM TGMR313110","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":139972.56,"discounted_cash":34993.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EXCLUDER ILIAC BRANCH ENDOPROSTHESIS ILIAC BRANCH COMPONENT 23MM X 14.5MM X 10CM 16FR CEB231410A","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":78774.28,"discounted_cash":19693.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC PASCAL PRECISION SYSTEM PASCAL ACE IMPLANT 20000ISMA","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT PEG MIC 20FR PULL ENFIT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":907.07,"discounted_cash":226.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENFIT MIC KEY JEJUNAL TUBE 18FR 3CM 8230-18-3.0","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1637.8,"discounted_cash":409.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER 18-14CM x 4MM G47327","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":867.88,"discounted_cash":216.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBOLIZATION NESTER 7CM X 3MM G47338","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":798.46,"discounted_cash":199.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE IMPELLA CP 4.0 9F","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":169000.0,"discounted_cash":42250.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TYRX ANTIBACTERIAL ENVELOPE LARGE - MEDTRONIC","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8964.95,"discounted_cash":2241.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOLIZATION EMBOZENE 400UM MICROSPHERES 2ML-CELO NOVA","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOLIZATION EMBOZENE 250UM MICROSPHERES 2ML","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1596.5,"discounted_cash":399.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBO RUBY COIL400 6MMX30CM COMPLX STAND - PENUMBRA","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":11622.9,"discounted_cash":2905.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBO RUBY COIL400 6MMX20CM COMPLX STAND - PENUMBRA","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8919.9,"discounted_cash":2229.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBO RUBY COIL400 5MMX30CM COMPLX STAND - PENUMBRA","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":11622.9,"discounted_cash":2905.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBO RUBY COIL400 5MMX12CM COMPLX STAND - PENUMBRA","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8919.9,"discounted_cash":2229.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COIL EMBO RUBY COIL400 3MMX12CM COMPLX STAND - PENUMBRA","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8919.9,"discounted_cash":2229.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AMPLATZER VASCULAR PLUG 4 7MMX12.5MMX125CM .038","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":10361.5,"discounted_cash":2590.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENTGRAFT EXCLUDER 20MMX9.5CM 12F CONTRLAT LIMB AAA-GORE","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38895.39,"discounted_cash":9723.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STENTGRAFT EXCLUDER 18MMX11.5CM 12F CONTRLAT LIMB AAA-GORE","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38895.39,"discounted_cash":9723.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT ENDO EXCLUDER 12FR 16MM 13.5CM PLC161400","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38895.39,"discounted_cash":9723.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AAA ENDOANCHOR IMPLANT AND HELIFX APPLIER 16F-APTUS","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":39757.5,"discounted_cash":9939.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC MITRACLIP CDS0706-NT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC MITRACLIP CDS0706-NTW","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC MITRACLIP CDS0706-XT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC MITRACLIP CDS0706-XTW","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE GASTROSTOMY FEEDING MIC 18FR ENFIT 810018","code_information":[{"code":"27800000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"gross_charge":212.59,"discounted_cash":53.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BEADS HYDROPEARL EMBOLIZATION 800UM HP2S0800","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE EMBOLIZATION PIPELINE FLEX SHEILD TECHNOLOGY 4.75X12MM PED2-475-12","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":104780.0,"discounted_cash":26195.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE NASOGASTRIC FEEDING 8FR 55IN DOBBHOFF ENFIT WEIGHTED","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":97.37,"discounted_cash":24.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT PEG MIC 20FR PUSH OTW ENFIT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":907.07,"discounted_cash":226.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COLOPLAST TITAN ASSEMBLY KIT (INCLUDES IMPLANTS) #91-9480SC","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOLIZATION VASCULAR PLUG II 12MMX9MMX100CM 6F-ST JUDE","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":7496.32,"discounted_cash":1874.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBO VASCULAR PLUG 2 14MMX10MM 6FX100CM - ST JUDE","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":7496.32,"discounted_cash":1874.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT PIN-PLUG MEDTRONIC PACER 6725","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":206.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"EMBOLIZATION VASCULAR PLUG II 10MMX7MMX100CM 6F-ST JUDE","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":7496.32,"discounted_cash":1874.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENFIT MICKEY LOW PROFILE JEJUNAL TUBE 14FR 3.0CM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1637.8,"discounted_cash":409.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENFIT MICKEY GASTRO JEJUNAL TUBE 22FR 3.0CM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":3225.14,"discounted_cash":806.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP INTERNAL RESOLUTION 360 M00521231","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":2255.7,"discounted_cash":563.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONDUIT AORTIC VALVED KONECT RESILIA 25MM 11060A25","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":108160.0,"discounted_cash":27040.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC TRICLIP G5 CLIP DELIVERY SYSTEM XT TCDS0801-XT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SOFT TISSUE NEOX AMNIOTIC MEMBRANE ALLOGRAFT 7X7CM  NX-02-7070","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":24231.15,"discounted_cash":6057.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT CARDIOVASCULAR HEMASHIELD GOLD MICROVEL 2 VELOUR STRAIGHT TUBE 60CM 6MM M002020952060","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":4351.85,"discounted_cash":1087.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE SAPIEN 3 ULTRA RESILIA THV 23MM 9755RSL23A","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":229840.0,"discounted_cash":57460.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE SAPIEN 3 ULTRA RESILIA THV 26MM 9755RSL26A","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":229840.0,"discounted_cash":57460.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE SAPIEN 3 ULTRA RESILIA THV 29MM 9755RSL29A","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":229840.0,"discounted_cash":57460.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE SAPIEN 3 ULTRA RESILIA THV 20MM 9755RSL20A","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":229840.0,"discounted_cash":57460.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE MITRAL EPIC PLUS TISSUE 19X29MM E200-29M","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INTEGRA WOUND MATRIX THIN 2 X 2 IN 52021","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":20733.58,"discounted_cash":5183.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEET SILICONE 5CM X 5CM X 0.25MM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":174.08,"discounted_cash":43.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC TRICLIP XTW 4TH GENERATION SYSTEM DELIVERY TCDS0301-XTW","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE MITRAL EPIC PLUS TISSUE 20X31MM E200-31M","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE AORTIC HEART ON-X CONFORM-X 23MM ONXACE-23","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":34149.6,"discounted_cash":8537.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT RESTRICTOR BONE PREP KIT SMALL 0206-703-000","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":5174.44,"discounted_cash":1293.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SOFT TISSUE STRAVIX UMBILICAL ALLOGRAFT 2X2CM 4 SQ CM PS60006","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":8784.75,"discounted_cash":2196.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE GENEX 5CC 910-005Z","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":10361.5,"discounted_cash":2590.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FLEXIGRAFT ACHILLES TENDON 250MM 2419288-1005","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":13946.67,"discounted_cash":3486.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MATRIX TISSUE STRATTICE 20X30CM 2030002ET","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":143873.08,"discounted_cash":35968.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHUNT FLEXCEL STRAIGHT CARTOID INLYING DISPOSABLE 14FR 5-PACK 2020-45","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE MITRAL EPIC PLUS TISSUE 20X33MM E200-33M","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SKIN FLEXHD PLIABLE ACELLULAR DERMAL MATRIX 12X120CM PF2220","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":44780.29,"discounted_cash":11195.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM EMBOLIC TRUFILL 1 GM 632500NA","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":31757.45,"discounted_cash":7939.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT STENT ENDURANT II 4FR 16X124MM ETLW1616C124E","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":39439.44,"discounted_cash":9859.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE COCR ACC 2.0MM W/CLAMP   #71340007","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":5769.28,"discounted_cash":1442.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE HEART AORTIC MOSAIC 25MM 305C225","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":38183.94,"discounted_cash":9545.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MESH INTEGRA BILAYER WOUND MATRIX 2X2IN MWM2021","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":30116.6,"discounted_cash":7529.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE FEEDING JEJUNOSTOMY 14 FR O.D.","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":1713.41,"discounted_cash":428.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TUBE GASTROSTOMY FEEDING MIC 24FR ENFIT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":212.59,"discounted_cash":53.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT STENT ENDURANT IIS 20FR 14-36X103MM ESBF3614C103E","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":67571.52,"discounted_cash":16892.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT DURAGEN 2 X 2","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC MITRACLIP G5 CLIP DELIVERY SYSTEM NT CDS0801-NT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT SOFT TISSUE NEOX AMNIOTIC MEMBRANE 6X3CM NX-10-6030","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VALVE MITRAL EPIC PLUS TISSUE 17X27MM E200-27M","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC MITRACLIP G5 CLIP DELIVERY SYSTEM XT CDS0801-XT","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC MITRACLIP G5 CLIP DELIVERY SYSTEM XTW CDS0801-XTW","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC MITRACLIP G5 CLIP DELIVERY SYSTEM NTW CDS0801-NTW","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC TRICLIP G5 XTW CLIP DELIVERY SYSTEM TCDS0801-XTW","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEVICE EMBOLIZATION WEB SL DISPOSABLE 2X6MM W5-6-2","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"gross_charge":105930.89,"discounted_cash":26482.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHEET SILICONE 5CM X 5CM X 0.25MM","code_information":[{"code":"27800000","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.08,"discounted_cash":43.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ENDOLOGIX DETOUR SYSTEM TORUS STENTS ENDOCROSS DEVICE BUNDLE","code_information":[{"code":"27801604","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1604","type":"HCPCS"}],"standard_charges":[{"gross_charge":169000.0,"discounted_cash":42250.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW GEMINUS CORTICAL LOCK 3.5x14mm COLS-35140-TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.1,"discounted_cash":224.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LOW PROFILE 3.5 X 18MM AR-8935-18","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TITANIUM COMPRESSION CANNULATED 3X14X36MM 04.334.236","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TN ADVANCED PEEK ADULT TIBIAL MR CONDITIONAL 9X390MM 04.043.150S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15499.54,"discounted_cash":3874.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE STANDARD 5 HOLE SHAFT 3.5MM X 114MM 241.903","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13225.78,"discounted_cash":3306.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE APTUS TITANIUM TAPER CORTICAL 2 THREAD HEXADRIVE SELF TAP 2X12MM A-5400.12/1","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.6,"discounted_cash":262.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TRI-LOCK APTUS TITANIUM TAPER CORTICAL 2 THREAD SELF TAP 2X8MM A-5450.08/1","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.1,"discounted_cash":430.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE APTUS TITANIUM SELF DRILL CANNULATED HEXADRIVE 2.2X5X13MM A-5780.13/1","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3625.6,"discounted_cash":906.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE APTUS TITANIUM SELF DRILL CANNULATED HEXADRIVE 2.2X12X34MM A-5781.34/1","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3625.6,"discounted_cash":906.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD CD HORIZON SOLERA TITANIUM PERCUTANEOUS 5.5X40MM 654000040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9253.27,"discounted_cash":2313.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD CD HORIZON SOLERA TITANIUM PERCUTANEOUS 5.5X45MM 654000045","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9253.27,"discounted_cash":2313.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LCP COMBI SS CONTOUR HUMERUS PERIARTICULAR LEFT PROXIMAL 10H 3.5X235MM 02.123.029S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15401.69,"discounted_cash":3850.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LCP COMBI SS CONTOUR HUMEROUS PERIARTICULAR LEFT PROXIMAL 8H 3.5X199MM 02.123.027S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14859.29,"discounted_cash":3714.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE COALITION AGX 6X18MM 1128.1506","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28541.7,"discounted_cash":7135.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE COALITION AGX 7X18MM 1128.1507","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28541.7,"discounted_cash":7135.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INTRAMEDULLARY FEMORAL RIGHT PROXIMAL TFNA LATERAL RELIEF CUT 125D 9X400MM 04.037.930S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18661.42,"discounted_cash":4665.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE XL25 LOCKING IM NAIL 5X44MM 04.045.044TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE NEON3 OCCIPITAL MIDLINE 47MM CS 3913-08","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13740.25,"discounted_cash":3435.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SS SHORT THREAD CANNULATED SELF TAP 3X14MM 202.614","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2563.77,"discounted_cash":640.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KREULOCK TI 3.5X16MM AR-8935CL-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KREULOCK TI 3.5X18MM AR-8935CL-18","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KREULOCK TI 3.5X26MM AR-8935CL-26","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD CD HORIZON SOLERA TITANIUM PERCUTANEOUS 5.5X55MM 654000055","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9253.27,"discounted_cash":2313.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW GEMINUS CORTICAL NON LOCK 3.5x13mm PANL-35130-TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.1,"discounted_cash":224.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW GEMINUS CORTICAL LOCKING 35x13 COLS-35130-TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.1,"discounted_cash":224.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LISFRANC PLATE MEDIUM LEFT TI AR-8951ML","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PEG GEMINUS THREADED NON LOCKING VOLAR 2.7X22 TPNL-27220-TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.6,"discounted_cash":159.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CANNULATED SHORT THREAD 3.0X20MM 202.620","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2563.77,"discounted_cash":640.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PEG GEMINUS THREADED LOCKING 2.3X18 TPLS-23180-TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.1,"discounted_cash":224.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PEG GEMINUS THREADED LOCKING 2.3X17 TPLS-23170-TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.1,"discounted_cash":224.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE GEMINUS VOLAR DISTAL RADIUS 3H LEFT GMN-LTN-3HL","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7072.85,"discounted_cash":1768.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW 28MM AR-8935-28","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STEM FEMORAL ACTIS DUOFIX STANDARD OFFSET COLLAR CEMENTLESS TAPER 12/14 SZ 0 1010-11-005","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":20832.93,"discounted_cash":5208.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD SPINAL CD HORIZON SOLERA TI 5.5X130MM 654000130","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9253.27,"discounted_cash":2313.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INTRAMEDULLARY TITANIUM ELASTIC PURPLE 4X440MM 475.940","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3267.47,"discounted_cash":816.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE LOAD DBL FIBERTAK 2.6MM AR-3730SP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4377.5,"discounted_cash":1094.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TIBIA CORTICAL DISTAL SELF TAP LOCK TAPER T15 3.5X48MM 8161-35-048","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.15,"discounted_cash":282.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE FEMORAL NECK SYS ANTIROTATE 95MM 04.168.495S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3208.45,"discounted_cash":802.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE NCB UNIVERSAL LOCK SYSTEM 3.5X5.6X26MM 00-2369-026-35","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.99,"discounted_cash":226.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DISC INTERVERTEBRAL MOBI-C CERVICAL 5X17X19MM MB3795","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":43896.0,"discounted_cash":10974.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE 5.5X50MM 16015550","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT BONE KYPHON XPEDE PMMA CX01A","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1749.35,"discounted_cash":437.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KYPHON XPEDE BONE CEMENT AND MIXER KIT CX01B","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2249.42,"discounted_cash":562.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2474.36,"discounted_cash":618.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE 7.5X60MM 16017560","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT ALPHAGRAFT DBM FIBER FLOW 2.5CC 2008-025","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE ACP 3 LEVEL 48MM CA3000048","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ALPS COCR LOCK MULTIDIRECTIONAL T15 3.5X28MM 110018028","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.47,"discounted_cash":391.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FILLER BONE VOID CERAMENT GENTAMICIN 5ML A0535-06","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":34501.14,"discounted_cash":8625.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT BONE SIMPLEX HV GENTAMICIN 40.8GM 6195-1-001","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.82,"discounted_cash":388.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT BONE SIMPLEX HV GENTAMICIN 6195-1-010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.82,"discounted_cash":388.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SPINE CERVICAL ANTERIOR SELF TAP 4X14MM CBBB40014","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFN-ADVANCED LATERAL RELIEF CUT TI FEMORAL PROXIMAL CANNULATED 130D 10X320MM 04.037.052S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RESTRICTOR BONE CEMENT MEDIUM 0206-701-011","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5174.44,"discounted_cash":1293.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TN ADVANCED TI PEEK ADULT TIBIAL 9X345MM 04.043.135S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15499.54,"discounted_cash":3874.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE FULL THREAD CORTEX SELF TAP 2.7X40MM 202.840","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.31,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE TUBULAR COLLAR 8 HOLE 1X7X63MM 242.08","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1465.9,"discounted_cash":366.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE OSTEOGRIP NANO SHANK 5.5X50MM 55904505550","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SET MULTIAXIAL 4PK 559200008","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":37665.0,"discounted_cash":9416.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD CD HORIZON TITANIUM CURVE CP4 5.5X60MM 1553201060","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SCREW MODULEX OSTEOGRIP 6.5X30MM 55900506530","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6307.0,"discounted_cash":1576.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SCREW CD HORIZON MODULEX OSTEOGRIP NANO 5.5X35MM 55904505535","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SET CD HORIZON MULTIAXIAL 559200007","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18832.5,"discounted_cash":4708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE RESONATE SELF DRILL VA 4.6X16MM 1194.7616","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3625.6,"discounted_cash":906.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE RESONATE CERVICAL ANTERIOR 2 LEVEL 38MM 1194.2038","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TITANIUM LOW PROFILE 3.5X55MM AR-8935-55","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE RELINE POLYAXIAL 2 FULL CANNULATED 7.5X55MM 16217555","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12720.59,"discounted_cash":3180.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DISC INTERVERTEBRAL MOBI-C 6X17X19MM MB3796","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":41431.5,"discounted_cash":10357.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TIBIAL CORTICAL DISTAL SELF TAP LOCK T15 3.5X46MM 8161-35-046","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1338.08,"discounted_cash":334.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL RFN-ADVANCED FEMUR DISTAL RETROGRADE 5D 12X440MM 04.233.244S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CERVICAL ANTERIOR SELF TAP VARIABLE ANGLE 3.5X17MM 18008317","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1661.90,"discounted_cash":415.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPACER ALLOGRAFT FORGE CERVICAL 8X12X14MM 865.308S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10902.1,"discounted_cash":2725.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE CERVICAL ANTERIOR LEVEL 1 1.6V 22MM 18006122","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9241.02,"discounted_cash":2310.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE FULL THREAD CORTEX SELF TAP 2.7X32MM 202.832","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.31,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE FULL THREAD CORTEX SELF TAP 2.7X5X8MM 202.808","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.31,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PUTTY GRAFT BONE FIBER FLOWABLE OSSIFUSE 10CC 8263.0310S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8109.0,"discounted_cash":2027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PUTTY GRAFT BONE FIBER FLOWABLE OSSIFUSE 5CC 8263.0305S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE FULL THREAD CANCELLOUS 2.5X4X40MM 206.040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.60,"discounted_cash":38.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE TI TARSOMETATARSAL LOW PROFILE 3 HOLE 3MM AR-8952TT-03","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCK 5X80MM 04.045.080S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2574.95,"discounted_cash":643.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCK 5X54MM 04.045.054S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTICAL MINI FRAGMENT SYSTEM 2.7X40MM AR-18827-40","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE CEMENT SPINE VISCOSITY SYSTEM 10001127","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13515.0,"discounted_cash":3378.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":13963.70,"discounted_cash":3490.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE TI T10 FULL THREAD CORTEX SELF TAP STARDRIVE 3X18MM AR-8933-18","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFN-ADVANCED LATERAL RELIEF CUT TI COCR FEMORAL LEFT 130D 9X320MM 04.037.953S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18661.42,"discounted_cash":4665.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE PINNACLE DOME ACETABULAR CANCELLOUS SELF TAP 6.5X40MM 1217-40-500","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE XL25 LOCK LOW PROFILE 4X30MM 04.045.530S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.4,"discounted_cash":678.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE XL25 LOCK LOW PROFILE 4X36MM 04.045.536S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.4,"discounted_cash":678.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ANTIROTATE FEMORAL NECK SYSTEM 90MM 04.168.490S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3208.45,"discounted_cash":802.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI T25 SELF TAP LOCK STARDRIVE 5X36MM 412.212S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2523.19,"discounted_cash":630.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE XL25 LOCK 5X44MM 04.045.044S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT ORTHOPEDIC FEMORAL NECK SYSTEM 80MM 04.168.280S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4758.6,"discounted_cash":1189.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ANTIROTATE FEMORAL NECK SYSTEM 80MM 04.168.480S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3208.45,"discounted_cash":802.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI T25 SELF TAP LOCK STARDRIVE 5X34MM 412.211S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2523.19,"discounted_cash":630.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE TI FEMUR NECK 1 HOLE 04.168.000S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8419.85,"discounted_cash":2104.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE PUTTY CATALYST NANOSYNTHETIC OSSDSIGN 5CC 104050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17028.9,"discounted_cash":4257.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE PUTTY CATALYST NANOSYNTHETIC OSSDSIGN 10CC 104100","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":21678.3,"discounted_cash":5419.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE TI T10 FULL THREAD CORTEX SELF TAP 3X38MM AR-8933-38","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TN ADVANCED TI PEEK ADULT TIBIAL 10X330MM 04.043.230S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15499.54,"discounted_cash":3874.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT BONE SIMPLEX HV 20ML 40GM 6194-1-001","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.85,"discounted_cash":131.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE TI LOW PROFILE PLANTAR LAPIDUS LEFT AR-8941PL","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13469.95,"discounted_cash":3367.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT FIXATION FEMORAL 75MM 04.168.275S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4758.6,"discounted_cash":1189.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE FIBERTAK BUTTON 2.6MM AR-3780SP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5098.5,"discounted_cash":1274.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL RFN-ADVANCED TI FEMUR DISTAL RETROGRADE 5D BEND 12X360MM 04.233.236S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE TI T10 FULL THREAD CORTEX SELF TAP STARDRIVE 3X22MM AR-8933-22","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE APTUS TI COMPRESSION SELF DRILL CANNULATED HEXADRIVE 18X5MM A-5780.18/1","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3625.6,"discounted_cash":906.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD SPINAL RELINE TI LORDOTIC MAS 5.5X140MM 11355140","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD CD HORIZON TITANIUM CURVE CP4 5.5X50MM 1553201050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI CORTICAL LOW PROFILE 3X44MM AR-8933-44","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"VIVIGEN FROZEN FORMABLE CELLULAR BONE MATRIX MEDIUM 5.4CC BL-1625-002","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":22096.8,"discounted_cash":5524.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE TIBIAL DISTAL POSTEROLATERAL 4 HOLE LEFT 58MM AR-9943PLTL-04","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11667.95,"discounted_cash":2916.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFN-ADVANCED LATERAL RELIEF CUT TI RIGHT PROXIMAL CANNULATED 130D 235X12MM 04.037.244S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15641.36,"discounted_cash":3910.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DISC INTERVERTEBRAL MOBI-C COCRMO UHMWPE HA TI CERVICAL 15X15X6MM MB3556","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":41431.5,"discounted_cash":10357.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LCP COMBI CLAVICLE ANTERIOR SUPERIOR 4 HOLE RIGHT 81MM 02.112.010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7101.05,"discounted_cash":1775.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL BLADE TFN-ADVANCED TI HELICAL FEMORAL PROXIMAL CANNULATED 10.35X110MM 110 04.038.410S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6512.79,"discounted_cash":1628.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE APTUS TRI-LOCK CORTICAL HEXADRIVE LOCK 2X18MM A-5450.18/1","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.1,"discounted_cash":430.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE T15 TAPER TIBIAL CORTICAL DISTAL SELF TAP LOCK 3.5X50MM 8161-35-050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.19,"discounted_cash":274.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAGE SPINAL EZSPAND PLIF 10D 9X27MM 8.5-13MM 360-S092710","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TITANIUM CANCELLOUS CANNULATED SELF TAP FIX ANGLE 4X55MM AR-8740-55PTS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUBSTITUTE BONE FIBERGRAFT GPS SMALL PUTTY BIOACTIVE 4CC 76000040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8757.72,"discounted_cash":2189.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CANNULA BONE CEMENT GPS PUTTY BIOACTIVE FIBERGRAFT 200MM 75000200","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE FIBULA LCP COMBI SS CONTOUR RIGHT DISTAL LATERAL 9H 151MM 02.112.148","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5536.19,"discounted_cash":1384.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MESH CRANIAL LEVEL ONE ULTRAONE 3D 25-008-72-09","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9313.19,"discounted_cash":2328.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LORENZ HIGH TORQUE CROSS DRIVE EMERGENCY MAGENTA 1.8X3.5MM 911803","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":103.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE T2 ALPHA LOCKING 5X35MM 2360-5035S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE T2 ALPHA LOCKING 5X50MM 2360-5050S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INTRAMEDULLARY T2 ALPHA TIBIAL 9X300MM 2341-0930S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE KREULOCK 3MM X 30MM AR-8933VCL-30","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT SCP PREFILL KNEE 5CC SIDE-DEL11GA 464502","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":33446.52,"discounted_cash":8361.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE OSTEOGRIP NANO SHANK 6.5X50MM 55904506550","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE OSTEOGRIP NANO SHANK 7.5X40MM 55904507540","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE T TIBIAL MINI FRAGMENT SYSTEM 6 HOLE 2.7MM AR-18827P-19","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10766.95,"discounted_cash":2691.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTICAL MINI FRAGMENT SYSTEM 2.7X50MM AR-18827-50","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE THRESHOLD PEDICLE 5.5X50MM 530-5550","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8559.5,"discounted_cash":2139.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOCKING APREVO ALIF-X 3-PACK 5.5X25MM 1145.25.3","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14416.0,"discounted_cash":3604.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC APREVO ANTERIOR ALIF-X ALIF L5/S1 PLAN D.L51.02","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC APREVO LATERAL LLIF L3/L4 PLAN C.L34.02","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NC APREVO LATERAL LLIF L2/L3 PLUS C.L23.03","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0050,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE TITANIUM STRAIGHT LOW PROFILE 4 HOLE AR-8952TS-04","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE OSTEOGRIP NANOLOCK 6.5X45MM 55904506545","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD CD HORIZON TITANIUM CURVE CP4 5.5X40MM 1553201040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE TI T10 FULL THREAD CORTEX SELF TAP STARDRIVE 3X20MM AR-8933-20","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE STRUXXURE CERVICAL ANTERIOR 2 LEVEL 40MM 31-2-40","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8334.25,"discounted_cash":2083.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE STRUXXURE CERVICAL ANTERIOR SELF DRILL VARIABLE 4.35X14MM 32-6-4314","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE AXSOS TITANIUM SELF TAP LOCK 4X16MM 661016","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2358.7,"discounted_cash":589.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE AXSOS TITANIUM CORTEX 3.5X80MM 661480","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.4,"discounted_cash":123.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE AXSOS TITANIUM CORTEX 3.5X50MM 661450","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.4,"discounted_cash":123.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE AXSOS TITANIUM CORTEX 3.5X16MM 661416","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.4,"discounted_cash":123.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE AXSOS TITANIUM CORTEX 3.5X14MM 661414","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.4,"discounted_cash":123.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING 3.5X14MM AR-8935VCL-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3347.5,"discounted_cash":836.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CREO AMP CANNULATED MODULAR 7.5X50MM 1067.4750","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8226.13,"discounted_cash":2056.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MINI-MONSTER SHORT THREAD CANNULATED 3.5X42MM P20-135-042S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2343.25,"discounted_cash":585.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MINI-MONSTER SHORT THREAD CANNULATED 3.5X28MM P20-135-028S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2343.25,"discounted_cash":585.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE STRUXXURE 3 LEVEL 60MM 31-3-60","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9460.5,"discounted_cash":2365.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SS 1/3 THREAD REVERSE CUT FLUTE CANNULATED SELF TAP 4.5X38MM 214.538","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2593.13,"discounted_cash":648.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SPINE STRUXXURE SELF TAP 4.35X14MM 32-8-4314","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SPINE STRUXXURE SELF TAP 4.0X14MM  32-8-4014","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE SPINE 3-LEVEL STRUXXURE 57MM 31-3-57","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9460.5,"discounted_cash":2365.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE FIBULA LOCKING DISTAL TITANIUM 8-HOLE RIGHT AR-9943BR-08","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7613.45,"discounted_cash":1903.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE RELINE 2C POLYAXIAL REDUCTION MAS 6.5X60MM 16026560","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11262.5,"discounted_cash":2815.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MINI-MONSTER SHORT THREAD CANNULATED 3.5X38MM P20-135-038S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2343.25,"discounted_cash":585.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INTRAMEDULLARY TIBIAL TN ADVANCED PEEK ADULT 11X330MM 04.043.330S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15499.54,"discounted_cash":3874.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE QUICKFIX TI T15 SHORT THREAD CANNULATED 4X42MM AR-8740-42PTS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LCP COMBI STAINLESS STEEL NARROW 8H 4.2X13.5X152MM 224.581","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4456.09,"discounted_cash":1114.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INTRAMEDULLARY RFN-ADVANCED BEND FEMUR 5D 11X360MM 04.233.136S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SCREW OSTEOGRIP NANO 6.5X35MM 55904506535","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WIRE FIXATION THREAD 2X15X125MM M744","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.8,"discounted_cash":453.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LCP COMBI SS STANDARD RADIUS RIGHT DISTAL VOLAR VA SHAFT 2H HEAD 7H 2.4X47MM 02.111.720","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10724.15,"discounted_cash":2681.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SET MODULEX NANOLOCK 6.5X30MM 55904506530","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SET SINGLE HEAD MODULEX   5.5/6MM ROD 559200006","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10136.25,"discounted_cash":2534.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI T25 FULL THREAD TIBIAL SELF TAP LOCK 5X74MM 04.005.564","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1629.36,"discounted_cash":407.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TITANIUM SHORT THREAD COMPRESSION SELF TAP 2.5X8X32MM 04.333.132","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LONG SS VA TAPER TIP EXTENDED LCP COMBI LEFT 4 HOLE 2.7/3.5X111MM 02.117.704","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13472.47,"discounted_cash":3368.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SCREW CD HORIZON OSTEOGRIP NANO 6.5X40MM 55904506540","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE FULL THREAD CORTEX SELF TAP SMALL HEXAGONAL 4X6X48MM 206.448","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.51,"discounted_cash":89.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SCREW CD HORIZON OSTEOGRIP NANO 5.5X45MM 55904505545","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SCREW CD HORIZON OSTEOGRIP NANO 5.5X40MM 55904505540","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SCREW CD HORIZON OSTEOGRIP NANO 4.5X45MM 55904504545","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD CD HORIZON TITANIUM CURVE CP4 5.5X45MM 1553201045","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CROSSLINK PASS LP MEDIUM 4-72MM 5.5MM B02465520","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9010.0,"discounted_cash":2252.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LCP COMBI STAINLESS STEEL RIGHT ANTERIOR SUPERIOR 8H 3.5X135MM 02.112.020","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7688.23,"discounted_cash":1922.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TITANIUM SELF TAP LOCK STARDRIVE T25 5X32MM 412.210S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2523.19,"discounted_cash":630.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SS REVERSE CUT FLUTE SELF TAP CANNULATED 2.9X6.5X7.9X50MM 208.405","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.95,"discounted_cash":832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE ALPS TIMAX HUMERUS RIGHT PROXIMAL 7H 140MM 110030402","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12799.16,"discounted_cash":3199.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SCREW OSTEOGRIP NANO 5.5X30MM 55904505530","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD CD HORIZON SOLERA TITANIUM PERCUTANEOUS 5.5X150MM 654000150","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9253.27,"discounted_cash":2313.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SHANK SCREW CD HORIZON MODULEX OSTEOGRIP NANO 4.5X50MM 55904504550","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9629.44,"discounted_cash":2407.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE RIGHT MED GORILLA P53-102-R002","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12345.95,"discounted_cash":3086.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MONSTER 7MM X 80MM P20-170-084F","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4820.4,"discounted_cash":1205.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MONSTER 4.5MM X 70MM P20-145-070F","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.43,"discounted_cash":694.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MONSTER 4.5MM X 60MM P20-145-060F","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.43,"discounted_cash":694.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MONSTER 4.5MM X 55MM P20-145-055F","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.43,"discounted_cash":694.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE GORILLA 3.5MM X 54MM P50-453-3554","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TITANIUM COMPRESSION CANNULATED 4X24X60MM 04.334.460","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE GORILLA 3.5MM X 44MM P50-453-3544","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE GORILLA 3.5MM X 52MM P50-453-3552","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE NCB FEMUR CORTICAL SELF TAP POLYAXIAL 3.5X4X26MM 02.03155.026","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.34,"discounted_cash":251.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE NCB FEMUR CORTICAL SELF TAP POLYAXIAL 3.5X4X24MM 02.03155.024","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.34,"discounted_cash":251.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CANNULATED SELF TAP 4X44MM 325044","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CANNULATED SELF TAP 4X50MM 325050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CANNULATED THREAD PARTIAL 4X40MM 325040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING 5X42MM XL25 04.045.342S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.4,"discounted_cash":678.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TIBIAL TITANIUM ADVANCED 8X300MM 04.043.020S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17091.61,"discounted_cash":4272.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE GORILLA 3.5MM X 38MM P50-453-3538","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.8,"discounted_cash":401.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE FIBULAR DISTAL LOCKING TI 5H RIGHT AR-9943BR-05","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6307.0,"discounted_cash":1576.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CAPUTURE CORITCAL 5.0 X 36MM 8001-036","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM EMBOLIC LAVA-18 6ML SLLES186","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":49560.0,"discounted_cash":12390.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD RELINE-O TITANIUM STRAIGHT 5.5X600MM 15355600","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3577.08,"discounted_cash":894.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SET PRECEPT 8800000","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.87,"discounted_cash":227.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MINI-MONSTER FULL THREAD CANNULATED 3X22MM P20-130-022F","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2343.25,"discounted_cash":585.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW AUGMENT OPTETRAK STACK 15MM 208-10-15","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1493.5,"discounted_cash":373.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MINI-MONSTER 3.0X26MM P20-530-026S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.43,"discounted_cash":694.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PEG INSET GLENOID CIRCULAR 24MMX5DEG 2N2AI24005","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":23343.93,"discounted_cash":5835.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MONSTER 2.0X10MM P24-020-010L","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2604.36,"discounted_cash":651.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION K WIRE 2.4MM 0S1GK00002","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.5,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD RELINE TITANIUM THORACOLUMBAR 5.5X400MM 16355400","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3577.08,"discounted_cash":894.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD ANODIZED TITANIUM PRE-LORDOSED 5.5X50MM 14550-050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SS T15 LONG THREAD CANNULATED SELF TAP 4X45MM AR-8840CL-45","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE OPTETRAK TIBIAL EXTENSION EXTENSION STEM 7MM 204-70-00","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.95,"discounted_cash":171.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SHORT-HEADED 1.0\" 02-029-99-1003","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.3,"discounted_cash":285.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LATERAL MASS 4X16MM CS 3903-40-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5586.2,"discounted_cash":1396.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LONG SHAFT CANNULATED 4X32MM CS 3904-40-32","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6667.4,"discounted_cash":1666.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR ROD RELINE-O INLINE 2H 5-6MM 11108055","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CONNECTOR ROD RELINE-O FIX CROSS 5.5X25MM 10055325","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6314.93,"discounted_cash":1578.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUBSTITUTE GRAFT BONE OSTEO-P CARBOHYDRATE POLYMER POROUS 20CC BGS-G20","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":20925.0,"discounted_cash":5231.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW POLYAXIAL PEDICLE REDUCTION CANNULATED 6.5X45MM 43566545","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE SCREWS TITANIUM CORTEX 2.4X12MM AR-8916CX24-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SET PICASSO II POLYAXIAL MIS 019.1010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":128.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD PICASSO CURVE PERCUTANEOUS MIS 6X40MM 016.3040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD PICASSO CURVE PERCUTANEOUS MIS 6X35MM 016.3035","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE PICASSO II MIS 6.5X45X127MM 119.1645","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":1351.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE PICASSO II MIS 6.5X40X127MM 119.1640","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":1351.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION FULL THREAD SNAP OFF COMPRESSION 2.4X38MM AR-9924-38","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LONG SHAFT CANNULATED 4X28MM CS 3904-40-28","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6667.4,"discounted_cash":1666.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION FULL THREAD SNAP OFF COMPRESSION 2.4X26MM AR-9924-26","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT FIXATION NAIL SYSTEM TRIMMABLE 2.4X30MM OF2012430S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13515.0,"discounted_cash":3378.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LCP COMBI SS LEFT ANTERIOR 6 HOLE 3.5MM 02.112.027","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7300.71,"discounted_cash":1825.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTEX HEXAGONAL ANKLE FIXATION SYSTEM 3.2X14MM HEX3.2-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":206.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TORX CORTICAL 2.4X16MM TRX2.4-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LC-DCP SS T LARGE FRAGMENT SET 6 HOLE 116CM 240.16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.38,"discounted_cash":1004.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SS 1/2 THREAD REVERSE CUT FLUTE CANNULATED SMALL FRAGMENT 4X34MM 207.734","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.53,"discounted_cash":631.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LCP PRO-PAK STAINLESS STEEL LOW PROFILE 4H 2X31MM 247.344","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2270.74,"discounted_cash":567.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION FULL THREAD SNAP OFF COMPRESSION 2.4X32MM AR-9924-32","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SS CORTEX SELF TAP LARGE HEXAGONAL 3.5X4.5X8X56MM 214.856","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SS CORTEX SELF TAP LARGE HEXAGONAL 3.5X4.5X8X62MM 214.862","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SI-LOK WASHER 10X45MM 1202.6045S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28541.7,"discounted_cash":7135.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ACUTRAK 3 MICRO 18MM 3051-25018","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE VA CLAVICLE RIGHT 2.7MM 02.112.621","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9838.92,"discounted_cash":2459.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE EPIC CANNULATED HEADLESS 4.5X44MM 1001-4544","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE EPIC CANNULATED HEADLESS 4.5X36MM 1001-4536","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING 4.5X30MM 2000-4530","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":412.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING 4.5X28MM 2000-4528","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":412.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING 4.5X24MM 2000-4524","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1648.0,"discounted_cash":412.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CANNULATED SELF-DRILL 2.3 X 20MM L2320","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3296.0,"discounted_cash":824.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE NON LOCKING 4.5X34MM 2001-5534","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.5,"discounted_cash":270.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE ANTERIOR STRAIGHT 2000-8002","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12253.6,"discounted_cash":3063.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION FULL THREAD SNAP OFF COMPRESSION 2.4X50MM AR-9924-50","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE UNIVERSAL NEURO III TITANIUM CRANIOMAXILLOFACIAL LOW PROFILE 2X2H 53-34300","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3281.68,"discounted_cash":820.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COVER BURR HOLE UNIVERSAL NEURO III TITANIUM TAB LOW PROFILE 7MM 53-34507","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2633.09,"discounted_cash":658.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MONSTER 3/4 THREAD BITE BREAK OFF 2X12MM P24-020-012L","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2604.36,"discounted_cash":651.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MINI-MONSTER SHORT THREAD HEADLESS 2.5X17MM P20-525-017S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.43,"discounted_cash":694.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE NON LOCKING 4.5X30MM 2001-5530","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1081.5,"discounted_cash":270.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE SCREWS TITANIUM CORTEX 2.4X20MM AR-8916CX24-20","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CANNULATED SELF-DRILL 2.3 X 22MM L2322","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3296.0,"discounted_cash":824.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MONSTER THREADED 2.0 X 13MM P24-020-013L","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2604.36,"discounted_cash":651.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SI-LOK WASHER 10X40MM 1202.6040S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28541.7,"discounted_cash":7135.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE SI-LOK 10X45MM 1202.5045S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28541.7,"discounted_cash":7135.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ACETABULAR FIXATION 6.5X20MM 01-041-50-6520","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.85,"discounted_cash":204.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE ORTHOLOC STRAIGHT LEFT FIBULA LATERAL 89MM 5888402L","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15362.05,"discounted_cash":3840.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM FIXATION SUTURE ANCHOR TAPE NEEDLE SZ2 4.75MM OF1034753S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6712.45,"discounted_cash":1678.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TITANIUM T15 LARGE COMPRESSION CANNULATED HEADLESS 5X36MM AR-8750-36H","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4892.5,"discounted_cash":1223.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE RELINE POLYAXIAL 2 FENESTRATE 5.5X50MM 14215550","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10600.54,"discounted_cash":2650.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL HUMERAL TITANIUM MULTILOC CANNULATED 7.0 X 210MM 04.016.210S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15910.94,"discounted_cash":3977.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD ANODIZED TITANIUM PRE-LORDOSED 5.5X135MM 14550-135","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE PERSONA HEX 3.5X48MM 00-5901-035-48","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD RELINE TITANIUM STRAIGHT MAS 5.5X70MM 12355070","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3267.06,"discounted_cash":816.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ANCHOR FIBER SNARE 4.75MM OF1034751S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6261.95,"discounted_cash":1565.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ASNIS III SS PARTIAL THREAD REVERSE CUT CANNULATED 6.5X20X85MM 326085","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3429.9,"discounted_cash":857.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ASNIS III SS PARTIAL THREAD REVERSE CUT CANNULATED 6.5X20X80MM 326080","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3429.9,"discounted_cash":857.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE OSSIOFIBER 2 SNARE BLACK BLUE 4.75MM OF2034750S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13830.35,"discounted_cash":3457.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE PROSTEP MICA FULL THREAD 3X26MM 57S03026","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5739.37,"discounted_cash":1434.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPACER COALITION MIS TITANIUM 7D 8X15X18MM 1136.5878","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE SCREWS TITANIUM CORTEX 2.4X10MM AR-8916CX24-10","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI MINI FULL THREAD COMPRESSION 3.5X18MM AR-8730-18H","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI MINI FULL THREAD COMPRESSION SELF TAP 3.5X14MM AR-8730-14H","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD PICASSO CURVE PERCUTANEOUS MIS 6X95MM 016.3095","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE DHS DCP SS SHORT BARREL 150D 4 HOLE 281.840","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5147.94,"discounted_cash":1286.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE DHS DCP SS STANDARD BARREL 150D 4 HOLE 281.440","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5147.94,"discounted_cash":1286.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE DHS DCS SS CONDYLAR LAG 80MM 280.80","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3287.76,"discounted_cash":821.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LAG TELESCOPE INTERLOCK 10.5X105MM AR-9094-105","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8063.95,"discounted_cash":2015.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INTRAMEDULLARY EXTEND SHORT TROCHANTERIC RIGHT 130D 11MM 39CM AR-9094ES-11-3930R","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":24231.15,"discounted_cash":6057.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE NEURO LOW PROFILE TITANIUM 2Y 6H 0.5X21MM 421.517","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2284.13,"discounted_cash":571.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE PICASSO II PERCUTANEOUS POLYAXIAL SEMICLOSED MIS 6.5X35X127MM 119.1635","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":1351.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE BEVEL FULL THREAD 4X38MM AR-8740BV-38","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7162.95,"discounted_cash":1790.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE DART-FIRE HEADLESS CANNULATED COMPRESSION 2.5X20MM D2N25020","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.5,"discounted_cash":476.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAGE SUZUKA TITANIUM INTERBODY FUSION 5D 4X13.5X17MM S730504T","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10812.0,"discounted_cash":2703.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE CORTICAL HYBRID 3.5X38MM AR-8933HY-38","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE CORTICAL T10 2.7X70MM AR-8827-70","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.35,"discounted_cash":166.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE VAL CREULOCK TI COMPRESSION DISPOSABLE 3.7X16MM AR-8927VCL-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3347.5,"discounted_cash":836.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE CORTICAL HYBRID 3.5X28MM AR-8933HY-28","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE TITANIUM OLECRANON RIGHT DISPOSABLE 2 HOLE AR-7651R-02","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11667.95,"discounted_cash":2916.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE BEVEL FULL THREAD 4X50MM AR-8740BV-50","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7162.95,"discounted_cash":1790.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE ALLOSYNC CANCELLOUS COTTON WEDGE 5.5X16MM ABS-2800-1655","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14416.0,"discounted_cash":3604.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE VUEPOINT II 3.5X16MM 8975316","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6307.0,"discounted_cash":1576.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ANCHOR REVCON 4X50MM RSA4050-S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":24231.15,"discounted_cash":6057.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE T8 LONG THREAD COMPRESSION SELF TAP CANNULATED 3X9X22MM 04.334.222","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLE BONE DYNAFORCE NITINOL SUPER ELASTIC 10X10X10MM 2442-1010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLE BONE DYNAFORCE NITINOL ELASTIC 9X9X9MM 7009-0909KT","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10676.85,"discounted_cash":2669.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MOTOBAND CP POLYAXIAL LOCK 3.5X22MM 15PL-3522","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2018.8,"discounted_cash":504.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE DYNABUNION STANDARD LEFT 18MM 7108-DSTL","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":20799.45,"discounted_cash":5199.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE DART-FIRE SHORT EDGE COMPONENT HEAD 2.5X20MM D1125020","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3141.5,"discounted_cash":785.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD ACCELFIX TITANIUM CURVED 40MM 5.5X40MM 1054-5540S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE NEURO LOW PROFILE TITANIUM ADPATION 7 HOLE 0.5MM 421.519","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2562.64,"discounted_cash":640.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ACCELFIX POLYAXIAL DUAL THREADED 6.5X45MM 8103-6545S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8109.0,"discounted_cash":2027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET SCREW BONE ACCELFIX STAR OPEN 4.6MM 1309-0000S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TITANIUM LONG THREAD CANNULATED 4X26MM 04.354.426","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3546.19,"discounted_cash":886.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE STALIF C ABO TITANIUM STANDARD REVISION 4X16MM RAB1640","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD SPINE RELINE MAS TI STRAIGHT 5.5X150MM 12355150","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE DART FIRE CANNULATED 2.5MM X 22MM D1N25022S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1390.5,"discounted_cash":347.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE Q-FIX MINITAPE 2 PRELOAD BLUE COBRAID WHITE 72205860","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11870.68,"discounted_cash":2967.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"END CAP X-CORE 2 TITANIUM OD 18X40MM 6184000","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15787.23,"discounted_cash":3946.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ACCELFIX POLYAXIAL DUAL THREADED 6.5X40MM 8103-6540S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8109.0,"discounted_cash":2027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE STAINLESS STEEL T15 SHORT THREAD CANNULATED 4X36MM AR-8840C-36","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE JUGGERKNOT 2-LOAD TAPER 2.9MM 110005096","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2492.6,"discounted_cash":623.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ANCHOR REVCON 4X52MM RSA4052-S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":24231.15,"discounted_cash":6057.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE CO-BRAID MINI Q-FIX 1.8MM 72290123","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5991.2,"discounted_cash":1497.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT SIBER CORELINK TI SI COMPRESSION 11.5X50MM 44115-50","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30132.0,"discounted_cash":7533.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT SIBER CORELINK TI SI COMPRESSION 11.5X70MM 44115-70","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30132.0,"discounted_cash":7533.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT SIBER CORELINK TI SI COMPRESSION 11.5X40MM 44115-40","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30132.0,"discounted_cash":7533.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL THREADED TITANIUM IM 3.6X55MM IMN3.6-55T","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTICAL CAPTURE 5X40MM 8001-040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT ARTHROSCOPIC FIXATION Q-FIX MINI DISPOSABLE 1.8MM 72290125","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5723.06,"discounted_cash":1430.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTICAL CAPTURE 5X50MM 8001-050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTICAL CAPTURE 5X44MM 8001-044","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TIBIAL ARTHRODESIS FIXED LENGTH 9MM 36CM AR-9098-09-360","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17974.95,"discounted_cash":4493.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE STAINLESS STEEL CLAVICLE LEFT DISTAL LOW PROFILE PRECONTOUR 22D AR-2622DL","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7658.5,"discounted_cash":1914.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE ANCHORAGE T8 METATARSOPHALANGEAL RIGHT LOCK POLYAXIAL CROSS 626892","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":21159.36,"discounted_cash":5289.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE DART-FIRE FULL THREAD COMPRESSION EDGE 2.5X22MM D0325022","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4078.8,"discounted_cash":1019.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE MATRIX TENSIX DEMINERALIZED CRUSH MIX CHIPS 2.5ML PHG-02C","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12217.56,"discounted_cash":3054.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE STRAIGHT REINFORCE 6 HOLE 2.4MM AR-18724P-17","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTICAL CAPTURE 5X48MM 8001-048","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE COMPRESSION CANNULATED 5.0X38MM AR-8750-38H","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4892.5,"discounted_cash":1223.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE Q-FIX ULTRABRAID KNOTLESS CO-BRAID BLUE 72205883","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11931.58,"discounted_cash":2982.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD PICASSO CURVE PERCUTANEOUS 6X90MM 016.3090","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ANCHOR REVCON 4X54MM RSA4054-S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":24231.15,"discounted_cash":6057.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CANNULATED TI 6.5MMX85MM 408.412","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3348.94,"discounted_cash":837.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ASNIS MICRO CANNULATED 2.0X18MM 40-20118","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.3,"discounted_cash":517.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ASNIS MICRO CANNULATED 2.0X14MM 40-20114","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.3,"discounted_cash":517.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPACER COALITION MIS 7D 6X12X14MM 3136.1106","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28541.7,"discounted_cash":7135.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INFRAME S CANNULATED THREAD STABLE FIXATION 2X32MM EXINF922032","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11262.5,"discounted_cash":2815.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING XL25 5X36MM 04.045.036TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE Q-FIX ULTRABRAID KNOTLESS BLUE 72205882","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11931.58,"discounted_cash":2982.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING XL25 5X32MM 04.045.032TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING XL25 5X30MM 04.045.030TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INTRAMEDULLARY TN ADVANCED TIBIAL 11X315MM 04.043.325S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15499.54,"discounted_cash":3874.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING XL25 5X48MM 04.045.048TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING XL25 5X26MM 04.045.026TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR GRYPHON X PUSH IN BR WITH DYNACORD AND NEEDLES 271040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5658.28,"discounted_cash":1414.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD PICASSO CURVE PERCUTANEOUS 6X100MM 016.3100","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1854.0,"discounted_cash":463.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE PICASSO II PERCUTANEOUS 5.5X45X127MM 119.1545","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":1351.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCKING XL25 5X34MM 04.045.034TS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE CLIK SPINAL CORD SC-4318","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE POPLOK HI-FI 3.5MM CKP-3500","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2987.31,"discounted_cash":746.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI T15 LARGE FULL THREAD COMPRESSION CANN 5X42MM AR-8750-42H","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TFN-ADVANCED TI FEMORAL PROXIMAL CANN 3.5X10.35X110MM 04.038.210S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6207.53,"discounted_cash":1551.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE FIBERTAK SELF PUNCH 3 LOAD AR-3633SP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4223.0,"discounted_cash":1055.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ASNIS III TI PARTIAL THREAD REV CUT FLUTE CANN 4X50MM 604650","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.0,"discounted_cash":540.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE NEON3 LOCK CS 3901-01","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.5,"discounted_cash":167.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LCP SELF TAP LOCK VARIABLE ANGLE STARDRIVE 5X65MM 02.231.265","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BASEPLATE TIBIAL JOURNEY PORUS LOCK LEFT SZ 7 71425327","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":70410.6,"discounted_cash":17602.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHROSCOPIC FIXATION DOG BONE SUTURELASSO KNOTLESS BUTTON REPAIR SYSTEM KIT 3MM AR-2371BL","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16893.75,"discounted_cash":4223.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE COROENT VARIABLE ANGLE XLF SYSTEM 5.5X40MM 5485540","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE PUSHLOCK BIOCOMPOSITE SELFPUNCH 3.5MM AR-1926BCSP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":1158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW COMPRESSION INSTRUMENT 3.5MM THN00132","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7162.95,"discounted_cash":1790.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLE BONE JAWS NITINOL STRAIGHT 8X8MM P71-008-0808-S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10086.24,"discounted_cash":2521.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCK STERILE XL25 5X42MM 04.045.042S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2397.10,"discounted_cash":599.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE T15 SHORT THREAD CANN 4X50MM AR-8840C-50","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE CLAVICLE LOCK COMPRESSION RIGHT SMALL AR-2654CR","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7658.5,"discounted_cash":1914.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLE BONE LAPIPLASTY SPEEDPLATE ANATOMIC QUAD RAPID COMPRESSION 28X13X11MM SK50","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":27302.94,"discounted_cash":6825.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE BLUNT TIP LOW PROFILE CANN 4X36MM AR-5051-36","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ORTHOLOC FULL THREAD CORTICAL SELF TAP LOW PROFILE 3.5X14MM 58813514","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.4,"discounted_cash":303.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM FIXATION HAND WRIST INTERNAL BRACE LIGAMENT AUGMENTATION REPAIR KIT AR-8978-CP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13469.95,"discounted_cash":3367.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ECLIPSE CAGE MEDIUM 35MM AR-9301-02","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":37037.25,"discounted_cash":9259.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIXATION FIBERSTITCH 1.5 CURVED AR-19032C","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE LCP COMBI CURVE CONDYLAR 6 HOLE 4.5X159MM 02.124.406","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14045.69,"discounted_cash":3511.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BUTTON TIGHTROPE II ABS IMPLANT OPEN AR-1588TN-21","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BUTTON FIXATION TIGHTROPE ROUND CONCAVE 17MM AR-1588TB-17","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.5,"discounted_cash":708.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE CEMENT MAXIMUM VISCOSITY RADIOPAQUE 10001158","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13515.0,"discounted_cash":3378.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL FIBULOCK LEFT 3.8X130MM AR-8973L-38-130","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":25068.15,"discounted_cash":6267.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE ECLIPSE SPEEDCAP FIXATION SYSTEM AR-9400-SBK","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":20925.0,"discounted_cash":5231.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ECLIPSE CAGE SCREW SIZER AR-9401-08S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE FIBERTAK DOUBLE LOAD KNOTLESS 2.6MM AR-3740SP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ORTHOLOC FULL THREAD SELF TAP LOCK POLYAXIAL 3.5X10MM 58803510","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2358.7,"discounted_cash":589.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI T15 FULL THREAD COMPRESSION CANN HEADLESS SOLID LARGE 5X75MM AR-8750-75H","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4892.5,"discounted_cash":1223.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LCP SELF TAP LOCK VARIABLE ANGLE STARDRIVE T25 5X28MM 02.231.248","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LCP SELF TAP LOCK VARIABLE ANGLE STARDRIVE T25 5X20MM 02.231.220","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LCP SELF TAP LOCK VARIABLE ANGLE STARDRIVE T25 5X44MM 02.231.244","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FILLER BONE VOID CERAMENT 10ML A0210-08","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":22557.15,"discounted_cash":5639.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ACUTRAK 2 TI FULL THREAD COMPRESSION CANN 7.5X55MM 30-0755","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE CERVICAL ANTERIOR LEVEL 2 42MM 18006242","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE RELINE 2C MAS POLYAXIAL 7.5X50MM 16017550","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW DART-FIRE TI PARTIAL THREAD COMPRESSION CANN 4.0X50MM D1N40050S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1812.8,"discounted_cash":453.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE SPINAL LOCK TI CERVICAL 22MM 14-522222","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7027.8,"discounted_cash":1756.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI T25 FULL THREAD SELF TAP LOCK STARDRIVE BLUNT TIP 4.3X5X36MM 04.005.526","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1629.36,"discounted_cash":407.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD TAPER TIP GROOVED PRE-BENT 120MM 41006120","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING 5.0 X 34MM 04.005.524","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1629.36,"discounted_cash":407.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 6.5 X 80MM 32MM THREAD 208.438","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.95,"discounted_cash":832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 6.5 X 90MM 16MM THREAD 208.413","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.95,"discounted_cash":832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 6.5 X 85MM 16MM THREAD 208.412","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.95,"discounted_cash":832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 6.5 X 80MM 16MM THREAD 208.411","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.95,"discounted_cash":832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 2.7 X 18MM 202.818","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.31,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT BONE CEMENT STABILIT MX POWERCURVE VERTECOR LONG FRACTURE MX-2100L-01","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17880.35,"discounted_cash":4470.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 6.5 X 85MM 32MM THREAD 208.439","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.95,"discounted_cash":832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE T8 FULL THREAD STARDRIVE VARIAX 2.7X18MM 656418","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.9,"discounted_cash":316.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BUTTON FIXATION ENDO TI FEMORAL ARTHROSCOPIC STERILE DISP 12 X 4MM 013186","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.02,"discounted_cash":357.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ANKLE TITANIUM 2X13MM WS13","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3883.1,"discounted_cash":970.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BASEPLATE AEQUALIS FLEX REVIVE 30MM ARS655103","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9426.71,"discounted_cash":2356.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE RELINE POLYAXIAL MAS 2C 7.5X35MM 16017535","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE RELINE POLYAXIAL MAS 2C 6.5X40MM 16016540","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NMP FIBERS CORTICAL BONE LONG LARGE NMPFLGL","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTEX SELF TAP LARGE  3.5X8X4.5X52MM 214.852","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE Y-KNOT PRO RC 2 RIBBON YPRC02R","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4944.0,"discounted_cash":1236.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFN-ADVANCED LATERAL RELIEF CUT TI FEMORAL PROXIMAL CANN 130D 11X380MM 04.037.158S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW ARTHREX LOW PROFILE LOCKING 3.5 X 12MM AR-8835CL-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CRANIOFACIAL CROSS PIN INCREASE HEAD 2X10MM 92-50410","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.42,"discounted_cash":215.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI CANNULATED COMPRESSION HDLS 3X20MM 04.334.220","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACP PLATE 1.6X18MM 18006118","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE ORIOS MATRIX ALLOGRAFT XT 10CC BORXT010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":40803.75,"discounted_cash":10200.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WASHER ORTHOPEDIC 7MM AR-8870W","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.63,"discounted_cash":82.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE CLAVICLE LOCK COMPRESSION LEFT AR-2654CL","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7658.5,"discounted_cash":1914.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SPINE 5.5X45MM 43585545","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE T10 FULL THREAD CANCELLOUS SELF TAP NON-LOCK 3.0X22MM AR-8830-22","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE POPLOK SUBCORTICAL WING 4.5MM CKP-4500","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2987.31,"discounted_cash":746.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE VARIAX T8 FULL THREAD LOCK STARDRIVE 2.7X16MM 656316","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2173.3,"discounted_cash":543.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION HARMONY RIM MIS 3.2X45MM 74016465","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.2,"discounted_cash":216.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ALLY LX PD-32-302","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE TIBIAL RIGHT BEARING 3D SZ 4 15MM 03-PMR-15-0004","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":42480.0,"discounted_cash":10620.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORUS PCSS POSTERIOR 4MM DX-50-403","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":29713.5,"discounted_cash":7428.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CORUS PCSS LEVELONE 4MM DX-50-405","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":63720.0,"discounted_cash":15930.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CLIP ANKLE LOCK SZ 4 03-CMB-LC-0004","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM FIXATION SPEEDBRIDGE FIBERTAK BIOCOMPOSITE ACHILLES 3.9MM AR-9928BC-CP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":23394.15,"discounted_cash":5848.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TITANIUM LONG THREAD CANNULATED 4X32MM 04.354.432","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3546.19,"discounted_cash":886.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION HARMONY RIM MIS 3.2X30 MM 74016464","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.63,"discounted_cash":86.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE ACCELL CONNEXUS 10CC ALLOGRAFT 02-3000-100","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9458.25,"discounted_cash":2364.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE ACCELL CONNEXUS 5CC ALLOGRAFT 02-3000-050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6396.38,"discounted_cash":1599.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW POLYAXIAL 6.5X60MM 18-6560-13","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8109.0,"discounted_cash":2027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTICAL CAPTURE TROCHANTERIC 5X34MM AR-9093-50-034","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE NEON3 OCCIPITAL SELF TAP 5X8MM CS 3914-50-08","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW ARX POLYAXIAL 6.5X55MM 18-6555-13","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8109.0,"discounted_cash":2027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE NEON3 OCCIPITAL SELF TAP 5X6MM CS 3914-50-06","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTEX SELF TAP LARGE HEXAGONAL SOCKET 3.5X4.5X8X54MM 214.854","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT SIBER TITANIUM SI 11.5X65MM 44115-65","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30132.0,"discounted_cash":7533.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ECLIPSE CAGE ARTHROPLASTY SMALL 30MM AR-9301-01","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":37037.25,"discounted_cash":9259.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE RECONSTRUCTION INTERMEDULLARY NAIL XL40 6.5X80MM 04.046.680S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.4,"discounted_cash":678.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE RECONSTRUCTION INTERMEDULLARY NAIL XL40 6.5X90MM 04.046.690S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.4,"discounted_cash":678.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INTERMEDULLARY FEMORAL RIGHT CANNULATED RECONSTRUCTION 8H 140D 11X420MM 04.033.172S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":19803.42,"discounted_cash":4950.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE FULL THREAD COMPRESSION CANNULATED HEADLESS HEXAGONAL 7.5X60MM 30-0760","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR TENDON KNOTLESS XBRAID ICONIX BLUE 2 1.4MM 3911-714-522","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4995.5,"discounted_cash":1248.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT ANCHOR FLEXBAND TWIST 12CM TW012","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":41850.0,"discounted_cash":10462.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT MODULUS FIXATION 6X20MM 1460200","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6895.35,"discounted_cash":1723.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ANCHORAGE LAG CROSS PLATE T8 3.6X24MM 626924S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.6,"discounted_cash":545.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MINI-MONSTER SHORT THREAD CANNULATED HEADLESS 3X22MM P20-530-022S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.43,"discounted_cash":694.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE MINI-MONSTER SHORT THREAD CANNULATED HEADLESS 2.5X14MM P20-525-014S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.43,"discounted_cash":694.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ANCHORAGE LAG CROSS PLATE T8 3.6X22MM 626922","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.6,"discounted_cash":545.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT SIBER TITANIUM SI 11.5X30MM 44115-30","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30132.0,"discounted_cash":7533.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT SIBER TITANIUM SI 11.5X45MM 44115-45","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30132.0,"discounted_cash":7533.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT SIBER TITANIUM SI 11.5X60MM 44115-60","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30132.0,"discounted_cash":7533.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE CLAVICLE COMPRESSION SLOT 7 HOLE AR-2680ST","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7658.5,"discounted_cash":1914.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM FIXATION BIOBRACE RC DELIVERY 23X25MM BBRC-23","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30969.0,"discounted_cash":7742.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE NEON3 OCCIPITAL SELF TAP 5X10MM CS 3914-50-10","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.5,"discounted_cash":218.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW POLYAXIAL 6.5X50MM 18-6550-13","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8109.0,"discounted_cash":2027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW POLYAXIAL 6.5X45MM 18-6545-13","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8109.0,"discounted_cash":2027.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BN ALTEON ACETABULAR CANCELLOUS 6.5X20MM 180-65-20","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOW PROFILE TI CORTEX 2.4X14MM AR-8916CX24-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI T15 FULL THREAD COMPRESSION CANNULATED LARGE 5X65MM AR-8750-65H","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4892.5,"discounted_cash":1223.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM FIXATION SPEEDBRIDGE SWIVELOCK FIBERWIRE ACHILLES CANNULATED 3.9MM AR-9929BC-CP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":23017.5,"discounted_cash":5754.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD LOCKING CAP 5.5MM 148-059","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT SPINAL MODULUS ALIF 6X25MM 1460250","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE VARIAX T8 FULL THREAD LOCK STARDRIVE 2.7X18MM 656318","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2173.3,"discounted_cash":543.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE KREULOCK TI 3.5X10MM AR-8935CL-10","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT BONE SIMPLEX P RADIOPAQUE FULL DOSE 6191-1-001","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.85,"discounted_cash":131.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI PARTIAL THREAD REVERSE CUT FLUTE CANNULATED 6.5X90MM 408.413","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3348.94,"discounted_cash":837.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TI CANNULATED 6.5X95MM 408.414","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3348.94,"discounted_cash":837.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE MODULAR XLIF 10MM 1759451P2","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":26365.5,"discounted_cash":6591.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTEX LOW PROFILE 2.4X16MM AR-8916CX24-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBERSTITCH FIBERWIRE FIXATION KIT 24D 2-0 CURVE 1.5MM AR-4580-24","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD NEON3 TITANIUM OCT 9D CURVE 4X300MM CS 3913-40-05","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":669.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAGE SPINAL STALIF C-TI NO PROFILE PEEK TI 3 HOLE 6D 7.5X14MM C147561-3TC","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":20925.0,"discounted_cash":5231.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CANNULATED BLUNT TIP LOW PROFILE 4X38MM AR-5051-38","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"INFRAME EXSOMED INTRAMEDULLARY THRD MICRO NAIL 2X40MM EXINF922040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11262.5,"discounted_cash":2815.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE ARTHROCELL PLUS ALLOGRAFT VIABLE 2.5CC ABS-2090-02","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17119.0,"discounted_cash":4279.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL INTRAMEDULLARY FIBULOCK FIBULAR LEFT 3X180MM AR-8973L-30-180","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":25068.15,"discounted_cash":6267.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE OSSIOFIBER METAL COMPRESSION 3.5X20MM OF1073520S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10947.15,"discounted_cash":2736.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE ALLOGRAFT 20CC 2.5X10CM 06-0100-200","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":29936.48,"discounted_cash":7484.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE OSSIOFIBER METAL COMPRESSION 3.5X22MM OF1073522S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10947.15,"discounted_cash":2736.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPINAL SYSTEM FIXATION IFUSE TORQ 11.5X40MM 11540T","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":26993.25,"discounted_cash":6748.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE NEVOS DEMINERALIZED MATRIX ALLOGRAFT 10CC BNEFXT0010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14641.25,"discounted_cash":3660.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPINAL SYSTEM FIXATION IFUSE TORQ 11.5X55MM 11555T","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":26993.25,"discounted_cash":6748.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TORX CORTICAL 2.4X20MM TRX2.4-20","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTEX HEXAGONAL 3.2X12MM HEX3.2-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":206.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PEG FIXATION TORX THREAD 2.4X20MM TPEG2.4-20","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PEG FIXATION TORX THREAD 2.4X10MM TPEG2.4-18","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE TORX CORTICAL 2.4X22MM TRX2.4-22","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE NEVOS DEMINERALIZED MATRIX ALLOGRAFT 5CC BNEFXT0005","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4913.1,"discounted_cash":1228.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE VOLAR BEARING 3 HOLE RIGHT VBEAR-3-7S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9100.1,"discounted_cash":2275.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPINAL SYSTEM FIXATION IFUSE TORQ 11.5X45MM 11545T","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":26993.25,"discounted_cash":6748.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCK XL25 5X46MM 04.045.046S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE LOCK STERILE 5X38MM 04.045.038S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.24,"discounted_cash":554.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE VARIABLE ANGLE LOCK MINI FRAGMENT SYSTEM 2.7X34MM AR-18827V-34","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPACER SPINAL HERDON 7D 10X16X7MM 1213.6077S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12163.5,"discounted_cash":3040.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE COALITION AGX REDUCE PROFILE 16X7MM 1128.2407","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":20088.0,"discounted_cash":5022.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW TFNA-ADVANCED FENESTRATED 75MM 04.038.175S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7858.61,"discounted_cash":1964.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT MODULUS ALIF FIXATION 5.0X25MM 1450250","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CORTICAL LOCKING SELF TAPPING 3.5X22MM 661422","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.4,"discounted_cash":123.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT MODULUS ALIF FIXATION 5.0X20MM 1450200","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW VAL KREULOCK TI 3.0X12MM AR-8933VCL-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW COMPREHENSIVE CENTRAL REVERSE 6.5X20MM 115394","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE VARIAX CLAVICLE SUPERIOR LATERAL LFT 3H 74MM 628203","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13154.6,"discounted_cash":3288.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KRUELOCK COMPRESSION TI 2.4X14MM AR-8933VCL-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SHORT THREAD COMPRESSION CANN 2.5X30MM 04.333.130","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE DISTAL HUM LEFT 4 HOLE 2.7/3.5MM 02.117.104","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12140.34,"discounted_cash":3035.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BASEPLATE AEQUALIS PERFORM REVERSED 9.5X40MM DWJ240","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3770.83,"discounted_cash":942.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE STRAIGHT LOCK 12 HOLE 156MM AR-8943C-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6261.95,"discounted_cash":1565.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE 2.7 VA LOCKING PATELLA SS/3 HOLE SM 316L 02.137.001S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR FIXATION W/BIO SWIVELOCK 4.75X19.1MM AR-1593-BC","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6532.25,"discounted_cash":1633.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW RELINE MAS POLY 7.5X55 16027555","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9010.0,"discounted_cash":2252.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SPINAL ACP SELF DRILL VARIABLE 3.5X17 18008117","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE ALPS TIMAX PROX HIGH HUMERUS 4 HOLE RIGHT 110030401","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11322.33,"discounted_cash":2830.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW VALOR FUSION SYSTEM 5X65MM 4151150065","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD SPINAL CD HORIZON SOLERA TI 5.5X110MM 654000110","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD SPINAL CD HORIZON SOLERA TI 5.5X120MM 654000120","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING T8 STARDRIVE 2.7 X 12MM  202.212","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.32,"discounted_cash":274.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING 2.7 16MM  #202.216","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.32,"discounted_cash":274.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE NEURO CRANI 8H LOW PROFILE 5MM 421.523","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 6.5X75 208.437","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.95,"discounted_cash":832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 6.5X75 208.410","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.95,"discounted_cash":832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 6.5X70 208.409","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3331.95,"discounted_cash":832.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING 5.0X38 04.005.528","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1629.36,"discounted_cash":407.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE LCP 9 HOLE 116mm 223.591","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3287.66,"discounted_cash":821.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":3287.66,"discounted_cash":821.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SCREW TI LAG 10.5X95MM","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6000.66,"discounted_cash":1500.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW ACUTWIST ACUTRAK COMPRESSION 28MM AI-00028-S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2214.5,"discounted_cash":553.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE 1/3 TUBULAR 3 Hole 37MM w/COLLAR 241.33","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.51,"discounted_cash":125.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE T LT OBLIQUE 3.5 X 7 241.951","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4575.98,"discounted_cash":1144.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KREULOCK COMPRESSION 3.5X16MM AR-8835CL-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW RELINE POLYAXIAL 2 FULL CANN 8.5X55MM 16218555","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11262.5,"discounted_cash":2815.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KREULOCK TI 3.5X12MM AR-8935CL-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KRUELOCK COMPRESSION TI 3.0X16MM AR-8933VCL-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BASEPLATE AEQUALIS PERFORM REVERSED 9.5MMX35MM DWJ235","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3770.83,"discounted_cash":942.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE TIBIAL AXSOS 3 TI RIGHT 8 HOLE 149MM 627438","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":19711.35,"discounted_cash":4927.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBERGRAFT BONE GRAFT SUB GPS PUTTY MED 6 CC 76000060","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11577.85,"discounted_cash":2894.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFNA CANN TI RIGHT 130D 10X380MM 04.037.058S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SCREW T2 NAIL LOCKING FULL THREAD 5X35MM","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2338.1,"discounted_cash":584.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW COMPR FOOT MINI 3.5X38MM AR-8730-38H","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFNA TI CANN LATERAL 130D 9X170 SHORT LEFT 04.037.942S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13623.03,"discounted_cash":3405.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"R3CON NON LOCK PLATE SCREW 3.5x34mm P50-453-3534","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.72,"discounted_cash":315.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TFNA FENESTRATED SCREW 105mm STERILE 04.038.205S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6207.53,"discounted_cash":1551.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW HEX LOW PROFILE 6.5x25mm 7030-6525","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.08,"discounted_cash":241.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW HEX LOW PROFILE 6.5x15mm 7030-6515","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.08,"discounted_cash":241.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW HEX LOW PROFILE 6.5x20mm 7030-6520","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":964.08,"discounted_cash":241.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BASEPLATE AEQUALIS PERFORM 6.5X30MM DWJ130","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3770.83,"discounted_cash":942.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW PLATE R3CON NON LOCK 3.5x40mm P50-453-3540","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.72,"discounted_cash":315.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT PALACOS HIGH-VISCOSITY W/GENTAMICIN 40G 5036964","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.7,"discounted_cash":435.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TFNA FENESTRATED HELICAL BLADE 75mm STERILE 04.038.375S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6512.79,"discounted_cash":1628.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PERFORM REVERSED PERIPHERAL 5.0x38mm DWJ338","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.63,"discounted_cash":294.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TFNA FENESTRATED SCREW 85mm 04.038.185S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6207.53,"discounted_cash":1551.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BASEPLATE AEQUALIS PERFORM REVERSE 5.0X34MM DWJ334","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.63,"discounted_cash":294.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BONE PINS 4x110mm 144110","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.65,"discounted_cash":156.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TFNA FENESTRATED HELICAL NAIL BLADE 100mm ST 04.038.400S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8998.56,"discounted_cash":2249.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TFNA FENESTRATED SCREW 90mm STERILE 04.038.190S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6207.53,"discounted_cash":1551.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFNA HELICAL BLADE 85mm 04.038.385S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6512.79,"discounted_cash":1628.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD MEDTRONIC VOYAGER PERCUTANEOUS 100mm 654000100","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBERTAK RC DOUBLOAD TAPE BL/W BLK/W AR-3632SP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4068.5,"discounted_cash":1017.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL AFFIXUS HRN RIGHT 130DEG 11X320MM 8145-11-320","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ATTRAX SCAFFOLD STRIPS LG 5015102","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":37145.81,"discounted_cash":9286.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SOLERA VOAGER ROD 50mm 651000050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PERFORM REVERSED CENTRAL SCREW 6.5x40mm DWJ140","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3770.83,"discounted_cash":942.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE INFUSE SMALL KIT   7510200","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":36074.7,"discounted_cash":9018.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TFNA FENESTRATED HELICAL BLADE 80mm 04.038.380S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6512.79,"discounted_cash":1628.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELINE MAS SCREW RED POLY 2C 7.5x45mm 16027545","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9010.0,"discounted_cash":2252.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KIT FIXATION SPEEDBRIDGE SWVLCK FIBERTAPE 4.75 AR-2600SBS-8","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17209.1,"discounted_cash":4302.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"RELINE MAS SCREW RED POLY 2C 7.5x50mm 16027550","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9010.0,"discounted_cash":2252.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BASEPLATE REVERSE SHLDER CENTRAL 6.5x25mm DWJ125","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3770.83,"discounted_cash":942.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW NEURO LEVEL 1 DRILL FREE 1.5 x 4mm 99-576-76-01","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.99,"discounted_cash":141.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD MEDTRONIC VOYAGER TI 5.5x140mm 654000140","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":515.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"COMPR FT SCREW 7 XL 65mm AR-8770-65H","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6261.95,"discounted_cash":1565.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TFNA FENESTRATED SCREW 80mm 04.038.180S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6207.53,"discounted_cash":1551.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PUTTY REFICIO DBM 5CC 27800418","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5312.03,"discounted_cash":1328.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LOCKING THIRD TUBLAR PLATE TI 7H AR-9943T-07","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2626.5,"discounted_cash":656.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOCKING 3.5x24mm 661424","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.4,"discounted_cash":123.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PERFORM RESERVED PERIPHERAL SCREW 5x30mm DWJ330","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.63,"discounted_cash":294.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBULA NAIL LEFT 3x130mm AR-8973L-30-130","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":25068.15,"discounted_cash":6267.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PERFORM REVERSED CENTRAL SCREW 6.5x45mm NON STERILE DWJ145","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3770.83,"discounted_cash":942.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"AEQUALIS SCREW PERIPHERAL GLENOID 5x18mm DWJ318","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.63,"discounted_cash":294.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW PERIPHERAL AEQUALIS GLENOID REV 5.0X14 DWJ314","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.63,"discounted_cash":294.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"MOLDABLE DEMINERALIZED FIBERS 2CC BL-1800-02","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"FIBULA NAIL RIGHT 3x130mm AR-8973R-30-130","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":25068.15,"discounted_cash":6267.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFNA HELICAL BLADE 95mm 04.038.395S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6512.79,"discounted_cash":1628.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT SCREW VALOR 5x35mm 4151150035","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"WRIGHT SCREW VALOR 5x25mm 4151150025","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2935.5,"discounted_cash":733.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT BONE SIMPLEX HV 6194-1-010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.85,"discounted_cash":131.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING T8 STARDRIVE 2.7X14MM 202.214","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.32,"discounted_cash":274.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CORTICAL LOCKING 3.5X24MM  8161-35-024","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.18,"discounted_cash":274.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"DEPUY SCREW CORTICAL LOCKING 3.5X28MM  8161-35-028","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1066.26,"discounted_cash":266.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE FIBERTAK ROTATOR CUFF BLACK/BLUE AR-3652TTSP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4841.0,"discounted_cash":1210.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT SPINAL MOD ALIF FIXATION 6.0X15MM 1460150","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYSTEM SPINAL FIXATION IFUSE-TORQ 10.0X50MM 10050T","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":26993.25,"discounted_cash":6748.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BUTTON FIXATION TENSIONTIGHT DISP AR-2350","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7883.75,"discounted_cash":1970.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE FIBERTAK TIGHT ROPE WHITE/BLACK AR-3652SP","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4841.0,"discounted_cash":1210.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 55MM 204.855","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CABLE & SLEEVE SET 2.0MM BEADED 6704-0-520","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2922.42,"discounted_cash":730.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KREULOCK COMPRESSION 3.5X14MM AR-8835CL-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTICAL SELF-TAP STARDRIVE 14MM  #201.364.97","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.23,"discounted_cash":80.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE NUVASIVE FORMAGRAFT STRIPS LARGE X2  5010200","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8559.5,"discounted_cash":2139.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX BIOCOMPOSIT PUSHLOCKS 3.5X19.5MM  AR-1926BC","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SPINE PRODISC-C RETAINER SCREW 3.5X14MM 03.820.103","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2319.36,"discounted_cash":579.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER SCREW ACETABULAR 6.5X40MM 6250-65-40","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.02,"discounted_cash":292.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT SCREW CANNULATED LONG THREAD 4.0MM 50MM 207.750","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.53,"discounted_cash":631.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"IMPLANT PLATE COMPRESSN HP SHT BRL 4HL 78MM 1350 #281.540","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5147.94,"discounted_cash":1286.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER CABLE CERCLAGE W/CRIMP 1.8MM 2232-04-18","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3262.60,"discounted_cash":815.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER SCREW 3.0X20MM #40-30120","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.3,"discounted_cash":517.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX ANCHOR BIOCOMPOSITE SWIVLOK C 4.75X19.1MM AR-2324BCC","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4120.0,"discounted_cash":1030.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER CEMENT SIMPLEX WITH TOBRA FULL DOSE 6197-9-001","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":669.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SWIVELOCK DX FORKED EYELET 3.5X8.5MM AR-8978P","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4377.5,"discounted_cash":1094.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET CYLINDER SCROTAL ZERO DEG ANGLE 18CM W/PUMP ES8818","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":62296.92,"discounted_cash":15574.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SET IMPLANT FIBERTAK BICEPS W/1.9MM DRL GUIDES AR-3670","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5631.25,"discounted_cash":1407.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE VARIABLE ANGLE LOCK MINI FRAGMENT SYSTEM 2.7X12MM AR-18827V-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2008.5,"discounted_cash":502.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STAPLE MOTOCLIP HIMAX C 18X18X18MM 7118-1818-C","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":21720.15,"discounted_cash":5430.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW UNI NEURO SELF DRILLING AXIAL 1.5X4MM 56-15934","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.85,"discounted_cash":204.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ACL TIGHTROPE II W/INTERNAL BRACE AR-1588RT-IB","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT SPINAL BASE FIXATION 5.0X17.5MM 1450175","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT NEVOS DBM MATRIX PUTTY 5CC BNEP0005","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5856.5,"discounted_cash":1464.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT BONE HYDROSET CALCIUM PHOSPHATE INJECT 10CC 79-43910","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":23368.71,"discounted_cash":5842.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW METAPHYSEAL SELF-TAPPING 2.7X18MM 02.118.518","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.17,"discounted_cash":158.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE OSSIMEND BLOCK 10CC 62.5X20X8MM MCCB10","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16368.92,"discounted_cash":4092.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW ASNIS MICRO REV CUT FLUTE 3.0X28MM 40-30128","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.3,"discounted_cash":517.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW TI LONG THREAD COMPRESSION CANN 2.5X26MM 04.334.126","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE OSSIMEND BLOCK STRIP 10CC 12.5X2X0.4CM MCCB1004","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16368.92,"discounted_cash":4092.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BOLT SPINAL MOD ALIF FIXATION 5.0X15MM 1450150","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":901.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE TM SS CORTEX 2.7X12MM AR-8827-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW METAPHYSEAL SELF TAP LOW PROFILE 2.7X14MM 02.118.514","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.17,"discounted_cash":158.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"K-WIRE SINGLE ENDED TROCAR SMOOTH 2.0x150mm P99-192-2015","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.00,"discounted_cash":49.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES NEURO PLATE 6-HOLE STRUT 421.522","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3980.02,"discounted_cash":995.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LOW PROFILE CORTICAL SS 3.5X20MM AR-8835-20","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE LCP 8 HOLE 111MM 223.581","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3165.19,"discounted_cash":791.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 4.5 X 66MM 214.866","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 10MM 204.810","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.50,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 12MM 204.812","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 14MM 204.814","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 16MM 204.816","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 18MM 204.818","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 20MM 204.820","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 45MM 204.845","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 4.0 X 50MM SHORT THREAD 207.650","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.53,"discounted_cash":631.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PUTTY DBX 5CC 038050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 2.7 X 16MM 202.816","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.31,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 2.7 X 12MM 202.812","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.31,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 2.7 X 10MM 202.810","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.31,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 2.7 X 20MM 202.820","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.31,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING 3.5 X 14MM 212.103","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.24,"discounted_cash":289.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING 3.5 X 16MM 212.104","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.24,"discounted_cash":289.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING 3.5 X 18MM 212.105","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.24,"discounted_cash":289.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING 3.5 X 20MM 212.106","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.24,"discounted_cash":289.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 2.4X24MM  201.774","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.97,"discounted_cash":185.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 2.7 X 14MM 202.814","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.31,"discounted_cash":128.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER CABLE CERCLAGE W/CRIMP COCR 1.8X910MM 00-2232-002-28","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3873.71,"discounted_cash":968.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":3911.12,"discounted_cash":977.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES WASHER 13MM 219.99","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.00,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":261.0,"discounted_cash":65.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 7.3 X 80MM 16MM THREAD 208.880","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3315.26,"discounted_cash":828.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LOW PROFILE CORTICAL SS 3.5X14MM AR-8835-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LOW PROFILE CORTICAL SS 3.5X16MM AR-8835-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW IM LOCKING 5.0X42MM 04.005.532","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1629.36,"discounted_cash":407.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW TRILOGY TRAB METAL 6.5X25MM 6250-65-25","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.02,"discounted_cash":292.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW TRILOGY TRAB METAL 6.5X20MM 6250-65-20","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.02,"discounted_cash":292.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER BNE SCREW HIP/KNEE 6.5X30MM 6250-65-30","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.02,"discounted_cash":292.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING 5.0X32MM 04.005.522","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1629.36,"discounted_cash":407.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE ASNIS TI MICRO REV CUT CANN 5.0X3.0X22MM 40-30122","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.3,"discounted_cash":517.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW ASNIS MICRO REVESE CUT FLUTE 3.0X26MM 40-30126","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.3,"discounted_cash":517.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 7.3 X 105MM 16MM THREAD 208.905","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3315.26,"discounted_cash":828.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE BONE FIBULA LOCK LEFT 6 HOLE AR-8943DL-06","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE SYS FIX N TRACK SWIVELOCK 3.9BC AR-1665BCSL-39","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7208.0,"discounted_cash":1802.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KREULOCK COMPRESSION 2.7X14MM AR-8827CL-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KREULOCK COMPRESSION 2.7X16MM AR-8827CL-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW KREULOCK COMPRESSION 2.7X18MM AR-8827CL-18","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3038.5,"discounted_cash":759.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW RELINE 2 FULL CANN POLYAXIAL 5.5X50MM 16215550","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11262.5,"discounted_cash":2815.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHROSCOPIC FIXATION GRAVITY SYNCHFIX KIT 86SYN005","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10748.93,"discounted_cash":2687.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW FULL THREAD COUNTERSINK MULTILOC 4.5X42MM 04.019.042","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.75,"discounted_cash":577.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW MULTILOC TI FULL THREAD 4.5X28MM 04.019.028","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.75,"discounted_cash":577.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW MULTILOC FULL THREAD 4.5X36MM 04.019.036","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.75,"discounted_cash":577.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CEMENT BONE PALACOS R+G PRO 80 HIGH VISCOSITY 5081289","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4717.4,"discounted_cash":1179.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT OSTEO-P BGS BONE SUBSTITUTE 25X50X3 BGS-S25X50X3","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14190.75,"discounted_cash":3547.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE TI FL THRD HEX SLF DRL 4x28 AR-8940-28","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BASEPLATE REVERSE SHLDR PERIPH 5.0X22 DWJ322","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.63,"discounted_cash":294.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"TULIP HEAD REDUCTION CREO MIS L30 MM SPINE 1134.0100","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAP SPINE LOCKING CREO MIS 1134.0010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":231.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE CNN PART THREAD 4.0X44 AR-8740-44PTS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE CANC CORT NON-LOCK 2.7X14 AR-8827-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE CORT NON-LOCK 2.7 X 18 AR-8827-18","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE CORT NON LOCK 2.7 X 16 AR-8827-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.5,"discounted_cash":115.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW VAL LOW PROFILE TI 3.0X12MM AR-8933V-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW VAL KREULOCK TI 3.0X14MM AR-8933V-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SPINE TULIP OPEN RELINE 5.5MM 13550000","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW VARIAX FULL THREAD LOCKING 3.5 X 18MM 657318","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2420.5,"discounted_cash":605.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW NCB UNIVERSAL LOCKING 3.5 X 30MM 00-2369-030-35","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.99,"discounted_cash":226.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW NCB UNIVERSAL LOCKING 3.5 X 22MM 00-2369-022-35","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.99,"discounted_cash":226.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE T10 FULL THREAD 3.5 X 14MM 657414","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.4,"discounted_cash":329.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE T10 FULL THREAD 3.5 X 16MM 657416","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.4,"discounted_cash":329.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL CANNULTED TFNA 130DEG 11X420MM LEFT 04.037.163S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD SPINE TI CURVED MATRIX 5.5 X 125MM 04.636.125","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":643.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFNA CANN TI 130DEG 10 X 170MM STERILE 04.037.042S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13623.03,"discounted_cash":3405.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SUTURE ANCHOR SWIVELOCK PEEK 4.75X19.1 AR-2324PSLC","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3862.5,"discounted_cash":965.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SPINE CREO CANNULATED MODULAR 6.5X50MM 1067.4650","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW QUICKFIX SHORT PART THRD LOW PROF 4.0X45 AR-8740-40PTS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW NCB UNIVERSAL LOCKING 3.5 X 24MM 00-2369-024-35","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.99,"discounted_cash":226.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW NCB UNIVERSAL LOCKING 3.5 X 60MM 00236902035","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.99,"discounted_cash":226.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LOW PROFILE 3.5 X 16MM AR-8935-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SPINE SCREW TI MATRIX THREAD 6.0X35MM 04.639.635","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4738.0,"discounted_cash":1184.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LOW PROFILE 3.5 X 14MM AR-8935-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LOW PROFILE 3.5 X 30MM AR-8935-20","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE FIBULA LAT DIST 7H 2.7X3.5MM RIGHT 02.112.144","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5280.94,"discounted_cash":1320.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SPINE SCREW TI MATRIX THREAD 6.0 X 50MM 04.639.650","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4738.0,"discounted_cash":1184.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW 26MM AR-8935-26","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER PIN APEX SELF TAPPING SELF DRILL 5X180MM 5018-6-180","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1802.5,"discounted_cash":450.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ALLOGRAFT BONE MATRIX VIABLE CELLULAR 5CC ABS-2009-05","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":29295.0,"discounted_cash":7323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PIN LOCKING BUTTRESS ANGLED 1.8 X 12MM 02.210.082","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1770.88,"discounted_cash":442.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW EXPEDIUM TI 1 INNER MONOAXIAL SET 5.5MM 1797-02-000","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET SCREW NON-LOCKING REVERSE SHOULDER 4.75X25MM 180552","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET SCREW FIXED LOCKING 4.75 X 20MM 180551","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":257.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LO PROF NON-LOCK CANCELL 4.0X16MM AR-8840-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE VA 2.7/3.5MM 2 HOLE 69MM MED LEFT 02.117.502","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13057.38,"discounted_cash":3264.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OSTEOCEL NUVASIVE PRO CELLULAR BONE MATRIX LARGE 5016010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":33480.0,"discounted_cash":8370.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE CANNULATED TI TFNA 130DEG 11 X 170MM 04.037.142S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13623.03,"discounted_cash":3405.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW HEX CORTICAL LOW PROF SELF DRILL FT 3.5X34 AR-8935-34","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"OSTEOCEL PRO SMALL CELLULAR BONE MATRIX 5016001","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5119.1,"discounted_cash":1279.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GLOBUS SPINE SCREW VA SELF-DRILLING 3.6 X 16MM 184.156","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1236.0,"discounted_cash":309.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE OLECRANON VA LCP 2H 2.7 X 3.5MM 90MM LEFT 02.107.302","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11889.87,"discounted_cash":2972.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 LOW PROFILE CORTICAL 3.5 X 24MM 110017724","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.51,"discounted_cash":113.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 LOW PROFILE CORTICAL 3.5 X 26MM 110017726","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.11,"discounted_cash":116.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 7.3 X 100MM 16MM THREAD #208.900","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3315.26,"discounted_cash":828.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 4.5 X 26MM #214.826","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX FULL THREAD 4.5 X 28MM #214.828","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":193.12,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX FULL THREAD 4.5X130MM 214.830","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 4.5 X 36MM #214.836","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 4.5 X 38MM #214.838","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 4.5 X 44MM #214.844","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX SELF-TAPPING 4.5 X 46MM 214.846","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.13,"discounted_cash":48.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE 1/3 TUBULAR 8 HOLE 97MM W/Collar 241.38","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.15,"discounted_cash":155.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANNULATED 7.3 X 75MM 16MM THREAD #208.875","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3315.26,"discounted_cash":828.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE LOCKING DISTAL FIBULA 4 HOLE RIGHT AR-9943BR-04","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":1351.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ROD SPINE RELINE MAS TI LORDOTIC 5.5X45 11355045","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE TUBULAR LOCKING THIRD 6 HOLE AR-9943T-06","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2472.0,"discounted_cash":618.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 MULTIDIRECTIONAL LOCKING 3.5 X 54MM 110018054","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.46,"discounted_cash":391.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE DISTAL FIBULA 6 HOLE LOCKING LEFT AR-9943BL-06","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6982.75,"discounted_cash":1745.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE 1/3 TUBULAR 8 HOLE LONG BONE 626674","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4006.7,"discounted_cash":1001.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE LOCKING TUBULAR THIRD TI 8 HOLE AR-9943T-08","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2729.5,"discounted_cash":682.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT PUROS DBM BONE MATRIX CHIPS 5CC 84338005","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.5,"discounted_cash":1689.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT PUROS DBM BONE MATRIX CHIPS 10CC 84338010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14821.45,"discounted_cash":3705.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE CORTICAL NONLOCK T15 3.5X22 110017722","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.11,"discounted_cash":116.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CANNULATED SHORT THREAD 4.0X50MM AR-8740-50PTS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SPINE SCREW POLYAX HEAD MATRIX TOP LOAD 04.632.001","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3090.0,"discounted_cash":772.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CANCELLOUS 4.0 X 40MM PARTIAL THREAD 207.040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.64,"discounted_cash":36.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE LOCKING TUBULAR THIRD TI 4 HOLE AR-9943T-04","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2317.5,"discounted_cash":579.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 MULTI-DIRECTIONAL LOCKING 3.5 X 44MM 110018044","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1518.94,"discounted_cash":379.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE HUMERUS PROXIMAL HIGH 3H 80MM LEFT 110030300","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10514.58,"discounted_cash":2628.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 LOW PROFILE CORTICAL 3.5 X 28MM 110017728","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.24,"discounted_cash":112.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CORTICAL LOCKING 3.5 X 40MM 8161-35-040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.15,"discounted_cash":282.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CORTICAL LOCKING 3.5 X 42MM 8161-35-042","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.15,"discounted_cash":282.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE CORTICAL NONLOCKING 3.5X30 110017730","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.11,"discounted_cash":116.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 MULTI DIRECTIONAL LOCKING 3.5X4 110018042","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1518.94,"discounted_cash":379.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW VARIAX FULL THREAD 3.5 X 12MM 657412","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.4,"discounted_cash":329.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL CANNULATED TI TFNA 130D 11X360MM RIGHT 04.037.156S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18020.0,"discounted_cash":4505.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW SPINE RELINE MAS POLYAXIAL 2C 7.5X55MM 16017555","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9911.0,"discounted_cash":2477.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW MULTIDIRECTIONAL LOCKING TI 3.5X36 110018036","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1518.94,"discounted_cash":379.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW MULTIDIRECTIONAL LOCKING TI 3.5X46MM 110018046","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1513.40,"discounted_cash":378.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"GRAFT BONE VOID FILLER BIOCARTILAGE 1CC ABS-1010-BC","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8829.8,"discounted_cash":2207.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 MULTI-DIRECTIONAL LOCKING 3.5 X 50MM 110018050","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.18,"discounted_cash":376.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 MULTIDIRECTIONAL LOCKING 3.5 X 48MM 110018048","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1553.24,"discounted_cash":388.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 MULTIDIRECITONAL LOCKING 3.5 X 34MM 110018034","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.47,"discounted_cash":391.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW MULTIDIRECTIONAL LOCKING 3.5 X 30MM 110018030","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.47,"discounted_cash":391.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE CORTICAL NONLOCKING 3.5X20 110017720","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.11,"discounted_cash":116.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE CORTICAL TI 3.5 X 12MM AR-8935-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE FIBULA DISTAL LOCKING TI 6 HOLE RIGHT AR-9943BR-06","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6982.75,"discounted_cash":1745.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE HUMERAL ALPS TIMAX 3H HIGH 80MM RIGHT 110030400","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10412.50,"discounted_cash":2603.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 40MM 02.211.040","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 42MM 02.211.042","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 54MM 02.211.054","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SPINE TRANSCONNECTOR SNAP-ON 47-62MM 04.633.347","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW TI MATRIXNEURO SELF DRILLING 4MM 04.503.104.01","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.43,"discounted_cash":193.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW MATRIXNEURO SELF DRILLING 5MM 04.503.105.01","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.43,"discounted_cash":193.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"CAP END NCB TI ALUMINUM LOCK 3.5X8MM 02.03150.300","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1333.13,"discounted_cash":333.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER FEMUR SCREW UNICORTICAL 5 X 14MM LEFT 02.03151.014","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1333.13,"discounted_cash":333.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW 22MM AR-8935-22","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW 24MM AR-8935-24","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREW SCREW 32MM AR-8935-32","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LO PRO CORTICAL NONLOCK 3.5X18MM AR-8835-18","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.5,"discounted_cash":90.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW DHS/DCS LAG 12.7 X 85MM 280.285","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3169.93,"discounted_cash":792.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW CORTICAL LOW PROFILE 3.0 X 14MM AR-8933-14","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LOCKING LOW PROFILE 3.0 X 16MM AR-8933-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ANCHOR SUTURE BIOCOMPOSITE 5.5MM CORKSCREW AR-1927BCFT","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3553.5,"discounted_cash":888.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW CORTICAL 4.0 X 44MM 206.444","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.82,"discounted_cash":77.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 46MM 204.846","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BONE CORTEX  4.0 X 5 206.450","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.82,"discounted_cash":77.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PIN FIXATION PERCUTANEOUS REFERENCE SMALL 100MM STR 9733235","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3118.94,"discounted_cash":779.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ZIMMER FEMUR SCREW UNICORTICAL 5 X 12MM LEFT 02.03151.012","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1333.13,"discounted_cash":333.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW CORTEX 3.5 X 42MM 204.842","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":48.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW FOOT CORTICAL LOCKING 3.5 X 32MM 816135032","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.15,"discounted_cash":282.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VARIABLE ANGLE LOCKING 5.0 X 36MM 02.231.236","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF TAPPING 2.7X20MM 02.211.020","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF TAPPING 2.7X14MM 02.211.014","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BASEPLATE REVERSE SHLDR CENTRAL 6.5mmX35mm DWJ135","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3770.83,"discounted_cash":942.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROFILE CNN THREAD 4.0 x 46 AR-8740-46PTS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.5,"discounted_cash":424.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW PLATE R3CON NON LOCK 3.5 x 30mm P50-453-3530","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.72,"discounted_cash":315.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW TFNA 95mm STERILE 04.038.195S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8575.09,"discounted_cash":2143.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LEVEL 1 SCREW CRANIAL FACIAL 1 DRIVE 1.5 x 5mm 99-576-76-07","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.98,"discounted_cash":141.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"NAIL TFNA HELICAL BLADE 90mm 04.038.390S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6512.79,"discounted_cash":1628.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE DISTAL FIBULA 5 HOLE LOCKING LEFT AR-9943BL-05","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6307.0,"discounted_cash":1576.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"LO-PRO SCREW 3.0x12MM CORTICAL AR-8933-12","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":283.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW T15 MULTIDIRECTIONAL LOCKING  3.5 X 24MM 110018024","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.47,"discounted_cash":391.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF TAPPING 2.7X12MM 02.211.012","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KNOTLESS TIGHTROPE REPAIR KIT TI W/DRV AR-8925T","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13469.95,"discounted_cash":3367.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"PLATE HUMERAL DISTAL 3H 2.7/3.5MM SHORT LEFT 02.117.103","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13472.47,"discounted_cash":3368.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW NEURO ONEDRIVE DRILL FREE 1.5X4MM 99-576-76-51","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.99,"discounted_cash":141.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROF CANN FL THRD SELF DRILL 4.0X16 AR-8940-16","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW LOW PROF CORTICAL FL THRD SELF DRILL 3.5X50 AR-8935-50","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW MULTI DIRECTIONAL LOCKING T15 3.5X22 110018022","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1564.47,"discounted_cash":391.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES CABLE W/CRIMP 1.7 #298.801.01S","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4551.26,"discounted_cash":1137.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET SCREW CORTICAL 5.0X38MM 8145-50-038","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.6,"discounted_cash":411.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF TAPPING 2.7X18MM 02.211.018","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF TAPPING 2.7X16MM 02.211.016","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":1865.84,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"KNOTLESS TIGHTROPE REPAIR KIT WITH DRIVER AR-8925SS","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13469.95,"discounted_cash":3367.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW BASEPLATE REVERSE SHLDR PERIPH 5.0X26 DWJ326","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.63,"discounted_cash":294.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SCREW VARIABLE ANGLE LOCKING 5.0 X 50MM 02.231.250","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2150.74,"discounted_cash":537.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"},{"gross_charge":2150.74,"discounted_cash":537.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VARIABLE ANGLE LOCKING 5.0 X 38MM 02.231.238","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE PROXIMAL TIBIA 4 H 3.5 X 87MM LEFT 02.127.211","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12885.2,"discounted_cash":3221.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VARIABLE ANGLE LOCKING 3.5 X 75MM 02.127.175","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1449.21,"discounted_cash":362.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SPINE LOCKING CAP W/O SADDLE 09.632.099","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.5,"discounted_cash":193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"ARTHREX SCREW LOW PROFILE TI 3.5 X 38MM AR-8935-38","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.0,"discounted_cash":154.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 26MM 02.211.026","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 24MM 02.211.024","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 46MM 02.211.046","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE VA LCP ANT CLAVICLE 12H 2.7  X124MM 02.112.049","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7688.23,"discounted_cash":1922.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ROD HOFFMANN SEMI CIRCULAR EXT FIX 11X400 4922-8-400","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 60MM 02.211.060","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER ROD HOFFMANN SEMI CIRCULAR EXT FIX 11X450 4922-8-450","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5150.0,"discounted_cash":1287.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET SCREW CORTICAL LOCKING 3.5 X 38MM 8161-35-038","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.19,"discounted_cash":274.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 56MM 02.211.056","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 32MM 02.211.032","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA SELF-TAPPING STARDRIVE 5 X 83MM 02.231.285","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA SELF-TAPPING STARDRIVE 5 X 80MM 02.231.280","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"STRYKER VITOSS BBTRAUMA 5CC 2102-2205","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15802.64,"discounted_cash":3950.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE VA CONDYLE 8 HOLE 4.5MM RIGHT 02.124.408","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14316.89,"discounted_cash":3579.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF-TAPPING 2.7 X 44MM 02.211.044","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW LOCKING SELF-TAPPING 3.5 X 44MM 212.134","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1158.24,"discounted_cash":289.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET SHOULDER PIN STEINMANN THREADED TIP 405800","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1977.6,"discounted_cash":494.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCRW VARIABLE ANGLE LOCKING 5.0 X 70MM 02.231.270","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE CLAVICLE 2.7 X 3.5 VA LCP 10H 110MM 02.112.047","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7688.23,"discounted_cash":1922.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"BIOMET SCREW CORTICAL LOCKING 3.5 X 48MM 816135048","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.19,"discounted_cash":274.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VARIABLE ANGLE LOCKING 5.0 X 40MM 02.231.240","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.03,"discounted_cash":438.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF TAPPING 2.7 X 10MM 02.211.010","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.84,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES SCREW VA LOCKING SELF TAPPING 2.7 X 22MM 02.211.022","code_information":[{"code":"27801713","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1865.85,"discounted_cash":466.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"SYNTHES PLATE DHS 135 DEGREE 2 